Early Magnetic Resonance Imaging for Patients With Idiopathic Sudden Sensorineural Hearing Loss in an Emergency Setting

Abstract

Objective: The role of magnetic resonance (MR) imaging in idiopathic sudden sensorineural hearing loss (ISSHL) is controversial due to the inhomogeneity of clinical and MR protocols. The aim of this work is to relate early MR findings obtained immediately after the admission, with the clinical presentation, the audiological findings, and the outcomes of treatment. Study Design: Prospective observational study. Setting: Tertiary referral university center. Patients: Forty-seven patients (22 M, 25 F; age: 54.4 ± 17.5 yr) consecutively referred to the Department of Emergency for ISSHL. Interventions: All patients underwent the diagnostic and therapeutic work-up for ISSHL, and MR imaging within 72 hours from the admission, independently of the symptoms onset. All patients received the same treatment (systemic steroid therapy, intratympanic steroid injection, and hyperbaric oxygen therapy). Main Outcome Measure(s): MR patterns, clinical, and laboratory findings. Results: MR imaging was positive in 25 of 47 cases (53%), with a perfect agreement between clinical and MR examinations (Cohen K = 1) upon the affected ear. Three different radiological patterns were observed: labyrinthine haemorrhage (n = 5), acute inflammatory process (n = 14), isolated blood–labyrinth barrier breakdown (n = 6). By binary logistic regression, only vertigo was associated with a positive MR imaging [B = 2.8; p = 0.011; OR = 9.5 (95% CI: 2.2–40.8)] and the latter was the only variable associated with an unfavorable outcome [(B = 2.8; p = 0.02 OR = 12.8 (95% CI: 2.9–56.7)]. Conclusion: Patients affected by ISSHL with associated vertigo show a higher likelihood of having a positive MR imaging, which, in turn, seems to predict an unfavorable outcome.

Clinical Value of a Novel Magnetic Resonance Imaging Protocol and Prognostic Model Establishment for Sudden Sensorineural Hearing Loss: A Prospective Study

“…As a systematic review and meta-analysis of Lammers et al [2019] mentioned, knowledge of the time between the onset of SSNHL and MR was essential for proper interpretation of imaging findings since signal intensity of blood in the CSF changes due to the dissociation of hemoglobin. However, our results showed that the difference in the period from SSNHL onset to MR examination between MR+ and MR− groups was not statistically significant, similar to the results of previous studies [Lee et al, 2016;Wang et al, 2019;Conte et al, 2019;Min et al, 2020]. In our opinion, the reason may be that membranous labyrinthine hemorrhage was less common (21%) compared with labyrinthitis (79%) overall [Lammers et al, 2019], and only 1 case in our study.…”

“…In our study, 30.1% (28/93) patients with unilateral SSNHL had labyrinthine signal abnormalities, the positive rate was nearly the same as the range of previous studies (25.8%-64.5%). The large variability may be mainly due to the different MR protocols and different objects (bilateral or unilateral SSNHL) [Ryu et al, 2011;Berrettini et al, 2013;Lee et al, 2016;Liao et al, 2016;Byun et al, 2019;Conte et al, 2019]. It is worth noting that the cochlear lesions accounted for 90.6% (29/32) of the positive cases found by our MR protocol.…”

“…A radiologist with more than 30 years of clinical experience in head and neck radiology reviewed all MR images to make the pathogenic diagnosis according to the flowchart shown in Figure 1. Each MR sequence setting has its significance based on the previous studies [Conte et al, 2017;Lammers et al, 2019;Conte et al, 2019]. Pre-contrast T1WI was useful for identifying labyrinthine hemorrhage, which showed a high signal in T1WI.…”

The value of postcontrast delayed 3D fluid-attenuated inversion recovery MRI in the diagnosis of unilateral peripheral vestibular dysfunction

“…Vestibular and cochlear PE are also important parameters in the grading method proposed by Bernaerts ( 13 ). A different study showed that both T1-weighted and FLAIR MRI were negative in patients with idiopathic SSHL, but high signal on postcontrast delayed 3D-FLAIR MRI often indicated BLB disruption ( 24 ). However, in the present study, the presence of vestibular PE was noted in 9 patients, and all of these patients had isolated PE without the presence of EH.…”

Hearing Loss and Blood Coagulation Disorders: A Review

“…In addition, quantitative synthetic MRI has been reported to better detect high signal intensity in the affected inner ear compared to the 3D-FLAIR sequences [ 36 ]. MRI sequences with contrast enhancement evaluation and 4 h delayed acquisitions demonstrated higher precision in defining the site and extension of the inner ear lesions, especially for fluid compartments [ 37 ]. An MRI-based volumetric analysis of inner ear fluids has been also recently proposed in order to indirectly evaluate endolymphatic hydrops [ 38 ].…”