Evaluating Abnormal MRI in Asymmetric Sensorineural Hearing Loss

Are there specific audiometric and clinical factors that can predict a positive MRI in the evaluation of asymmetric sensorineural hearing loss?

Bottom Line
Patients with an unexplained, asymmetric sensorineural hearing loss that includes a 15 dB or greater difference at 3 kHz, unilateral tinnitus, or dizziness/vertigo are significantly more likely to have an abnormal MRI scan than patients who do not meet these criteria.

Background: Asymmetric sensorineural hearing loss occurs in about 35% to 50% of the population, depending on how strictly “asymmetric” is defined. Prior studies indicate only 2% to 8% of patients with an asymmetric sensorineural hearing loss have a vestibular schwannoma.

Study design: Retrospective chart review of 451 patients with asymmetric sensorineural hearing loss who had an MRI scan over a seven-year period.

Setting: Tertiary referral center.

Synopsis: In this study, 89.4% of all patients with an asymmetric sensorineural hearing loss had normal or unrelated MRI scans. Overall, 21 (4.7%) had a vestibular schwannoma, and 27 (6%) had other pathology that could account for their asymmetric sensorineural hearing loss, including labyrinthitis, infarct, and vascular abnormality. A multivariate analysis of audiometric criteria revealed only the 15 dB difference at 3 kHz to be significant. Patients with any asymmetric sensorineural hearing loss and unilateral tinnitus or dizziness/vertigo are significantly more likely to have an abnormal MRI finding.

Reference: Ahsan SF, Standring R, Osborn DA, Peterson E, Seidman M, Jain R. Clinical predictors of abnormal magnetic resonance imaging findings in patients with asymmetric sensorineural hearing loss. JAMA Otolaryngol Head Neck Surg. 2016;141:451–456.