In our study, those patients with a positive MRI had a constellation of symptoms and findings (asymmetric sensorineural hearing loss, tinnitus, vertigo, and abnormal ENG/VNG). Cost-effectiveness can be improved by ordering an MRI only when clinical examination and VNG point toward a central pathology. Clinical examination and appropriate testing should be factored when considering the cost-effectiveness of obtaining an MRI in patients with abnormal ENG/VNG findings.

A comprehensive ASNHL work-up may not be applicable to all patients. Laboratory serologic tests are highly cost effective in diagnosing treatable causes of ASNHL, such as syphilis and Lyme. Although radiographic imaging with MRI is not as cost effective, its value in detecting for acoustic neuroma is undeniable.

No abstract

Objective: Cochlear implantation is the emerging treatment of choice for severe and profound sensorineural hearing loss, yet there are conflicting data on outcomes in adults. There is significant variability in the literature concerning the exact effect of age on cochlear implant outcomes. We sought to evaluate the outcomes of cochlear implant performance stratified by age. Study Design: Retrospective review. Methods: Audiologic preoperative and postoperative evaluation consisted of word recognition scores (Consonant-Nucleus-Consonant). Complications were retrospectively collected after each cochlear implantation. A sub-analysis was performed comparing patients implanted at a younger (21-64 years) and older (65 and above) age. Results: A total of 240 patients were evaluated. Patients experienced a significant improvement in audiologic performance as seen with word recognition scores (p < 0.00001). The mean post-implant score was 44.6% (at 3 months) and 53.5% (at 24 months) at 50 dB compared to average pre-implantation aided score of 6%. There was no significant difference between postoperative performances in younger versus older patient groups. Multiple regressions showed no correlation with duration of deafness at time of implantation or age and performance. There was no significant difference in performance based on side of implantation. Conclusion: This is one of the largest series to date on hearing outcomes in adults who receive a cochlear implant. No statistical differences were noted between the younger and older groups or based on side of implantation. The audiologic benefit in the adult population is clearly demonstrated.

Our NIHL mouse model demonstrated dose-dependent Dex pretreatment otoprotection against NIHL with preservation of retrocochlear auditory neurons.