MR Imaging in Sudden Sensorineural Hearing Loss. Time to Talk

Abstract

Sudden sensorineural hearing loss is defined as acute hearing loss of the sensorineural type of at least 30 dB over 3 contiguous frequencies that occurs within a 72-hour period. Although many different causative factors have been proposed, sudden sensorineural hearing loss is still considered "idiopathic" in 71%-85% of cases, and treatments are empiric, not based on etiology. MR imaging implemented with a 3D FLAIR sequence has provided new insights into the etiology of sudden sensorineural hearing loss. Herein, we review the current management trends for patients with sudden sensorineural hearing loss, from the initial clinical diagnosis to therapeutic strategies and diagnostic work-up. We focused primarily on MR imaging assessment and discuss the relevance that MR imaging findings might have for patient management, pointing out different perspectives for future clinical research.

The clinical value of 4‐hour delayed‐enhanced 3D‐FLAIR MR images in sudden hearing loss

“…Hyperintensity on both pre‐contrast T1 images and 3D‐FLAIR images thus suggests the presence of methemoglobin, which is related to minor haemorrhage . Hyperintensity only on 3D‐FLAIR images indicates an increased concentration of protein due to increased permeability of the BLB .…”

“…12 Hyperintensity on both pre-contrast T1 images and 3D-FLAIR images thus suggests the presence of methemoglobin, which is related to minor haemorrhage. 5 Hyperintensity only on 3D-FLAIR images indicates an increased concentration of protein due to increased permeability of the BLB. 5 In addition, enhancement of the inner ear fluid space after gadolinium injection is considered to reflect breakdown of the BLB.…”

“…5 Hyperintensity only on 3D-FLAIR images indicates an increased concentration of protein due to increased permeability of the BLB. 5 In addition, enhancement of the inner ear fluid space after gadolinium injection is considered to reflect breakdown of the BLB. 13 The integrity of the BLB is critical for inner ear homeostasis, and maintenance of its structure.…”

“…Classically, the role of radiologic study in SSNHL is to examine the possible existence of retro‐cochlea pathologies, including vestibular schwannomas, brainstem infarctions and inner ear anomalies, rather than to identify inflammatory changes of the affected inner ear itself. However, recent studies have shown that the affected inner ear can be visualised by gadolinium (Gd)‐enhanced MR imaging . Yoshida et al reported that high signal intensities could be detected on three‐dimensional fluid‐attenuated inversion recovery (3D FLAIR) MR images in SSNHL, and they postulated that this radiologic finding might be associated with hearing recovery.…”

“…However, recent studies have shown that the affected inner ear can be visualised by gadolinium (Gd)-enhanced MR imaging. 5 Yoshida et al 6 reported that high signal intensities could be detected on three-di- The previously reported data suggested that 4-hour delayed images might provide additional information on inner ear status. 9 The aim of the present study was therefore to investigate whether one could consistently observe enhancement of affected structures using the suggested MR protocol (4 hour delayed 3T 3D FLAIR MR images with double-dose intravenous Gd), especially in unilateral SSNHL.…”