CT Temporal Bone CT of the temporal bone is not useful in looking for central causes of vertigo. CT Head Head CT without or with IV contrast may be used to look for central causes of dizziness, albeit with lesser sensitivity than MRI [40,54]. IV contrast may help in either detection or characterization of various neoplastic or inflammatory disease processes affecting the central nervous system. In patients presenting to the emergency department with acute onset of symptoms, CT may demonstrate intracranial hemorrhage as a rare central cause of dizziness [56]. CTA Head and Neck In patients suspected of vertebrobasilar insufficiency as a cause of episodic vertigo, CTA can be used to detect vascular stenosis or occlusion [41]. MRI Head and Internal Auditory Canal MRI is the modality of choice in evaluation of the brain in patients suspected to have central cause for vertigo. It can detect posterior fossa neoplasms, Chiari malformation, posterior fossa infarcts, and demyelinating lesions that may result in dizziness or vertigo [3,54,56-58]. Contrast administration can be helpful in detection or characterization of such lesions [58]. Compared to CT, MRI has a much higher sensitivity of detecting acute infarcts in patients with dizziness [40]. It should be noted that infarcts causing isolated vestibular symptoms are usually small, and normal initial MRI does not entirely exclude brain infarction as a cause for vertigo [59]. MRA Head and Neck In patients suspected of vertebrobasilar insufficiency as a cause of episodic vertigo, MRA can be used to detect vascular stenosis or occlusion [55]. MR Venography Head There is no evidence to support use of MRV in the initial workup of patients presenting with isolated vertigo. Summary of Recommendations Variant 1: CT temporal bone without IV contrast is the first-line imaging modality in patients presenting with acquired conductive hearing loss without any mass lesion seen within the middle ear cavity.
Hearing Loss and or Vertigo. CT Temporal Bone CT of the temporal bone is not useful in looking for central causes of vertigo. CT Head Head CT without or with IV contrast may be used to look for central causes of dizziness, albeit with lesser sensitivity than MRI [40,54]. IV contrast may help in either detection or characterization of various neoplastic or inflammatory disease processes affecting the central nervous system. In patients presenting to the emergency department with acute onset of symptoms, CT may demonstrate intracranial hemorrhage as a rare central cause of dizziness [56]. CTA Head and Neck In patients suspected of vertebrobasilar insufficiency as a cause of episodic vertigo, CTA can be used to detect vascular stenosis or occlusion [41]. MRI Head and Internal Auditory Canal MRI is the modality of choice in evaluation of the brain in patients suspected to have central cause for vertigo. It can detect posterior fossa neoplasms, Chiari malformation, posterior fossa infarcts, and demyelinating lesions that may result in dizziness or vertigo [3,54,56-58]. Contrast administration can be helpful in detection or characterization of such lesions [58]. Compared to CT, MRI has a much higher sensitivity of detecting acute infarcts in patients with dizziness [40]. It should be noted that infarcts causing isolated vestibular symptoms are usually small, and normal initial MRI does not entirely exclude brain infarction as a cause for vertigo [59]. MRA Head and Neck In patients suspected of vertebrobasilar insufficiency as a cause of episodic vertigo, MRA can be used to detect vascular stenosis or occlusion [55]. MR Venography Head There is no evidence to support use of MRV in the initial workup of patients presenting with isolated vertigo. Summary of Recommendations Variant 1: CT temporal bone without IV contrast is the first-line imaging modality in patients presenting with acquired conductive hearing loss without any mass lesion seen within the middle ear cavity.