A 64-year-old man presented with a 3-year history of progressive deafness and tinnitus of the left ear. He had no vertigo or imbalance. The findings of his physical examination, including otoscopy and otomicroscopy, were normal. One year earlier, a computed tomographic scan of his brain  had shown a lesion in the cerebellopontine angle (CPA) that was interpreted as an acoustic neuroma Figure 1. Audiometry, which was performed during his first visit ,showed a dead ear on the left and a downward-sloping sensorineural hearing loss in the right ear, compatible with presbycusis Figure 2. Magnetic resonance imaging (MRI) was then performed.  shows the CPA lesion Figure 3 before contrast injection, and Figure 4 shows a contrast-enhanced MRI scan.

Figure 1

 Figure 2

Figure 3

Figure 4