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Early Magnetic Resonance Imaging for Patients With Idiopathic Sudden Sensorineural Hearing Loss in an Emergency Setting

Conte, Giorgio*; Di Berardino, Federica‡,§; Zanetti, Diego‡,§; Iofrida, Elisabetta Francesca||; Scola, Elisa*; Sbaraini, Sara**; Filipponi, Eliana††; Cinnante, Claudia*; Gaini, Lorenzo Maria||; Ambrosetti, Umberto‡,§; Triulzi, Fabio*,†; Pignataro, Lorenzo||,¶; Capaccio, Pasquale||,¶

doi: 10.1097/MAO.0000000000002389
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Objective: The role of magnetic resonance (MR) imaging in idiopathic sudden sensorineural hearing loss (ISSHL) is controversial due to the inhomogeneity of clinical and MR protocols. The aim of this work is to relate early MR findings obtained immediately after the admission, with the clinical presentation, the audiological findings, and the outcomes of treatment.

Study Design: Prospective observational study.

Setting: Tertiary referral university center.

Patients: Forty-seven patients (22 M, 25 F; age: 54.4 ± 17.5 yr) consecutively referred to the Department of Emergency for ISSHL.

Interventions: All patients underwent the diagnostic and therapeutic work-up for ISSHL, and MR imaging within 72 hours from the admission, independently of the symptoms onset. All patients received the same treatment (systemic steroid therapy, intratympanic steroid injection, and hyperbaric oxygen therapy).

Main Outcome Measure(s): MR patterns, clinical, and laboratory findings.

Results: MR imaging was positive in 25 of 47 cases (53%), with a perfect agreement between clinical and MR examinations (Cohen K = 1) upon the affected ear. Three different radiological patterns were observed: labyrinthine haemorrhage (n = 5), acute inflammatory process (n = 14), isolated blood–labyrinth barrier breakdown (n = 6). By binary logistic regression, only vertigo was associated with a positive MR imaging [B = 2.8; p = 0.011; OR = 9.5 (95% CI: 2.2–40.8)] and the latter was the only variable associated with an unfavorable outcome [(B = 2.8; p = 0.02 OR = 12.8 (95% CI: 2.9–56.7)].

Conclusion: Patients affected by ISSHL with associated vertigo show a higher likelihood of having a positive MR imaging, which, in turn, seems to predict an unfavorable outcome.

*Neuroradiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico

Department of Pathophysiology and Transplantation, Università degli Studi di Milano

Audiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico

§Department of Clinical Sciences and Community Health, Università degli Studi di Milano

||Otolaringology—Head and Neck surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico

Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano

**Postgraduation School in Radiodiagnostics, Università degli Studi di Milano

††Direzione Professioni Sanitarie, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Address correspondence and reprint requests to Diego Zanetti, M.D., Audiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Via Pace 2, 20122 Milan, Italy; E-mail:

The authors disclose no conflicts of interest.

Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company