What is the role of imaging studies in the workup of sudden hearing loss?

Updated: Aug 28, 2019
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Approximately 1-2% of patients with ISSHL have internal auditory canal (IAC) or CPA tumors. Conversely, 3-12% of patients with vestibular schwannomas present with sudden hearing loss.

Magnetic resonance imaging (MRI) with gadolinium diethylenetriamine-pentaacetic acid (DPTA) enhancement is the criterion standard test for diagnosing CPA masses, especially because a 30-40% false-negative rate exists with auditory brainstem response (if hearing levels permit). The cost issue for MRI has been addressed by performing limited studies using fast spin echo techniques.

According to 2012 guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF), computed tomography (CT) scans are not helpful and expose the patient to ionizing radiation. Therefore, CT scans are not recommended in the initial evaluation of patients with presumptive SSNHL. [14] However, in young patients, for whom only a small possibility of detecting a vestibular schwannoma exists, a noncontrast temporal bone CT scan could be obtained. Anatomic defects such as a Mondini dysplasia or enlarged vestibular aqueduct might account for a sudden hearing loss.

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