There is recognised variation between ENT departments in exact imaging protocols for the workup of idiopathic sudden sensorineural hearing loss (ISSNHL) but a routine MRI to exclude retrocochlear pathology is standard, usually following immediate treatment with oral +/- intratympanic steroids. A national audit of management and outcomes of this condition is about to begin in the UK. This paper from Milan is therefore timely, highlighting the enhanced information that modern 3 Tesla MRI sequences (pre and post-contrast T1 and 3D-FLAIR) can demonstrate, such as labyrinthine haemorrhage, labyrinthine inflammation or blood–labyrinthine barrier breach. The authors prospectively followed 47 patients from A&E presentation with ISSNHL (on average one week after symptoms began) to one month following presentation, and MRI was performed in all within 72 hours of presentation, prior to starting the local treatment protocol (oral +/- salvage intratympanic steroids and hyperbaric oxygen). Thirty-eight percent presented with co-existent symptoms of vertigo. In 53% there were positive MRI findings, which were demonstrated on the side of the ISSNHL in all cases. The only statistically significant correlation of additional presenting symptoms with positive MRI findings was with vertigo. The positive MRI group had statistically significant unfavourable outcome at one month compared with those with a negative MRI. In a time of limited healthcare resources this paper concludes that these results, supported by previous literature, can recommend performing early MRI in patients with ISSNHL with vertigo. The limitation highlighted is that, as yet, a positive MRI does not change management. Although we can extrapolate that an earlier diagnosis of a likely aetiology could guide treatment and enable better counselling of patients on their expected outcomes, more detailed studies are needed to provide an evidence base for that.

Early Magnetic Resonance Imaging for Patients with Idiopathic Sudden Sensorineural Hearing Loss in an Emergency Setting.
Conte G, Di Berardino F, Zanetti D, et al.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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