MRI can demonstrate signal alterations induced by inflammation or hemorrhage within the cochlear contents, identify neoplasms within the cochlear labyrinth or IAC, assess the size of vestibular aqueducts, and visualize abnormalities affecting the brain parenchyma along the auditory pathways [21-25]. Although differential considerations may vary based upon sudden, fluctuating, or progressive nature of sensorineural hearing loss, MRI remains the imaging modality of choice for all these subcategories. MRI should be done using dedicated IAC protocol using thin sections across the IAC and the inner ear. These protocols include evaluation of the brainstem and thalami. Given the extreme rarity of cortical deafness, there is no strong evidence to recommend routine assessment of the entire brain parenchyma in addition to the MRI IAC protocol in patients presenting with isolated sensorineural hearing loss [26,27]. High-resolution 3-D T2-weighted images providing submillimeter assessment of fluid-filled inner ear structures and the IAC are highly sensitive for detection of diseases presenting with sensorineural hearing loss [27,28]. Visualization of inflammatory changes (eg, labyrinthitis, neuritis) as well as neoplasms, such as vestibular schwannomas, can be facilitated by administration of IV contrast [29,30]. However, there is insufficient evidence to prove incremental benefit of contrast administration beyond an MRI IAC protocol performed without IV contrast [27,28]. MRA Head There is no evidence to support use of MRA in the initial workup of patients presenting with isolated sensorineural hearing loss. MR Venography Head There is no evidence to support use of MRV in the initial workup of patients presenting with isolated sensorineural hearing loss. Variant 4: Mixed conductive and sensorineural hearing loss. Initial imaging. CT Temporal Bone CT scan of the temporal bones can delineate changes of otospongiosis, a common cause of mixed conductive and sensorineural hearing loss.
Hearing Loss and or Vertigo. MRI can demonstrate signal alterations induced by inflammation or hemorrhage within the cochlear contents, identify neoplasms within the cochlear labyrinth or IAC, assess the size of vestibular aqueducts, and visualize abnormalities affecting the brain parenchyma along the auditory pathways [21-25]. Although differential considerations may vary based upon sudden, fluctuating, or progressive nature of sensorineural hearing loss, MRI remains the imaging modality of choice for all these subcategories. MRI should be done using dedicated IAC protocol using thin sections across the IAC and the inner ear. These protocols include evaluation of the brainstem and thalami. Given the extreme rarity of cortical deafness, there is no strong evidence to recommend routine assessment of the entire brain parenchyma in addition to the MRI IAC protocol in patients presenting with isolated sensorineural hearing loss [26,27]. High-resolution 3-D T2-weighted images providing submillimeter assessment of fluid-filled inner ear structures and the IAC are highly sensitive for detection of diseases presenting with sensorineural hearing loss [27,28]. Visualization of inflammatory changes (eg, labyrinthitis, neuritis) as well as neoplasms, such as vestibular schwannomas, can be facilitated by administration of IV contrast [29,30]. However, there is insufficient evidence to prove incremental benefit of contrast administration beyond an MRI IAC protocol performed without IV contrast [27,28]. MRA Head There is no evidence to support use of MRA in the initial workup of patients presenting with isolated sensorineural hearing loss. MR Venography Head There is no evidence to support use of MRV in the initial workup of patients presenting with isolated sensorineural hearing loss. Variant 4: Mixed conductive and sensorineural hearing loss. Initial imaging. CT Temporal Bone CT scan of the temporal bones can delineate changes of otospongiosis, a common cause of mixed conductive and sensorineural hearing loss.