Absent stapedial reflex: Otosclerosis or middle ear tumor?

February 25, 2013
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We present an unusual case in which a patient diagnosed as having otosclerosis on the basis of clinical and audiologic findings actually had a middle ear facial nerve schwannoma. To the best of our knowledge, this is the first reported case in English literature in which a facial nerve schwannoma presented with conductive deafness of gradual onset and absent stapedial reflex with a normally functioning facial nerve. We also include a review of the literature.


Unilaterally absent stapedial reflex with both ipsilateral and contralateral stimuli could be caused by a lesion in the ipsilateral efferent pathway of the stapedial reflex arc (figure 1). The lesion can be in any of the following five places: (1) the motor nucleus of the facial nerve (e.g., ischaemia); (2) the facial nerve (e.g., Ramsey Hunt syndrome); (3) the nerve to the stapedius muscle (e.g., Bell palsy); (4) the stapedius muscle (e.g., myasthenia gravis); and (5) the stapes (e.g., otosclerosis).

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