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?

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.

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.

Citation: 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 [published online ahead of print February 26, 2015]. JAMA Otolaryngol Head Neck Surg.

—Reviewed by Larry Lundy, MD