The Role for Imaging in the Investigation of Isolated Objective Vestibular Weakness

2019 ◽  
Vol 161 (6) ◽  
pp. 1027-1030
Author(s):  
Deanna Gigliotti ◽  
Brian Blakley ◽  
Paige Moore ◽  
Jordan Hochman
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Skull Base ◽  
Vestibular Schwannoma ◽  
Brain Mri ◽  
Internal Auditory Canal ◽  
Retrospective Chart Review ◽  
Sensorineural Hearing ◽  
Lateral Skull Base ◽  
Tertiary Center

Objective Unilateral vestibular weakness has considerable potential etiologies. One source is a vestibular schwannoma. This article evaluates, in the absence of other symptoms and signs, if unilateral vestibular weakness is an analogue to asymmetric sensorineural hearing loss and serves as an indication for lateral skull base imaging. Study Design Retrospective chart review. Setting Academic tertiary center. Subjects and Methods All patients undergoing caloric assessment between January 1, 2012, and June 30, 2018, were investigated. Patients with unilateral vestibular weakness (a left-right difference >25% on electronystagmography) were included in the study. A provincial encompassing image library was surveyed for potential adequate imaging (computed tomography internal auditory canal infused, magnetic resonance imaging [MRI] brain, MRI internal auditory canal) of the target population within the preceding 5 years. Presence/absence of vestibular schwannoma on imaging was determined. Results Of the 3531 electronystagmography reports reviewed during the period, 864 patients were identified with unilateral vestibular weakness. Of these, 542 had sufficient imaging, and 14 vestibular schwannomas were identified. Only 1 individual had a vestibular weakness in isolation, while the remaining 13 patients also suffered from documented sensorineural hearing loss that would have mandated MRI scanning. Conclusion The results of our study suggest that, in isolation, vestibular weakness is an insufficient indicator for lateral skull base imaging.

scholarly journals Sudden sensorineural hearing loss in patients with vestibular schwannoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Koichiro Wasano ◽  
Naoki Oishi ◽  
Masaru Noguchi ◽  
Ko Hentona ◽  
Seiichi Shinden ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Clinical Features ◽  
Vestibular Schwannoma ◽  
Recovery Rate ◽  
Treatment Plan ◽  
Full Range ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Recurrence Time

AbstractClinical features of sudden sensorineural hearing loss (SSNHL) associated with vestibular schwannoma (VS) are not fully understood. Determining a treatment plan and explaining it to patients requires clinicians to clearly understand the clinical features related to the tumor, including SSNHL. To identify the full range of clinical features of VS-associated SSNHL, especially recovery of hearing following multiple episodes of SSNHL and what factors predict recovery and recurrence. A multicenter retrospective chart review was conducted in seven tertiary care hospitals between April 1, 2011, and March 31, 2020. We collected and analyzed dose of administered steroid, pure-tone audiometry results, and brain MRIs of patients diagnosed with VS-associated SSNHL. Seventy-seven patients were included. They experienced 109 episodes of audiogram-confirmed SSNHL. The highest proportion of complete recoveries occurred in patients with U-shaped audiograms. The recovery rates for the first, second, and third and subsequent episodes of SSNHL were 53.5%, 28.0%, and 9.1%, respectively. Recovery rate decreased significantly with increasing number of SSNHL episodes (P =0 .0011; Cochran-Armitage test). After the first episode of SSNHL, the recurrence-free rate was 69.9% over 1 year and 57.7% over 2 years; the median recurrence time was 32 months. Logarithmic approximation revealed that there is a 25% probability that SSNHL would recur within a year. SSNHL in patients with VS is likely to recur within one year in 25% of cases. Also, recovery rate decreases as a patient experiences increasing episodes of SSNHL.

scholarly journals Diagnostic Yield of MRI for Sensorineural Hearing Loss – An Audit

2020 ◽  
Vol 47 (5) ◽  
pp. 656-660
Author(s):  
Helen Wong ◽  
Yaw Amoako-Tuffour ◽  
Khunsa Faiz ◽  
Jai Jai Shiva Shankar
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Diagnostic Yield ◽  
Internal Auditory Canal ◽  
Auditory Brainstem ◽  
Sensorineural Hearing ◽  
Vestibular Evoked Myogenic Potentials ◽  
Clinical Indication ◽  
Presenting Symptoms ◽  
Brainstem Response

ABSTRACT:Purpose:Contrast-enhanced magnetic resonance imaging (CEMRI) of the head is frequently employed in investigations of sensorineural hearing loss (SNHL). The yield of these studies is perceptibly low and seemingly at odds with the aims of wise resource allocation and risk reduction within the Canadian healthcare system. The purpose of our study was to audit the use and diagnostic yield of CEMRI for the clinical indication of SNHL in our institution and to identify characteristics that may be leveraged to improve yield and optimize resource utilization.Materials and methods:The charts of 500 consecutive patients who underwent CEMRI of internal auditory canal for SNHL were categorized as cases with relevant positive findings on CEMRI and those without relevant findings. Demographics, presenting symptoms, interventions and responses, ordering physicians, and investigations performed prior to CEMRI testing were recorded. Chi-squared test and t-test were used to compare proportions and means, respectively.Results:CEMRI studies revealed relevant findings in 20 (6.2%) of 324 subjects meeting the inclusion criteria. Pre-CEMRI testing beyond audiometry was conducted in 35% of those with relevant positive findings compared to 7.3% of those without (p < 0.001). Auditory brainstem response/vestibular-evoked myogenic potentials were abnormal in 35% of those with relevant CEMRI findings compared to 6.3% of those without (p < 0.001).Conclusion:CEMRI is a valuable tool for assessing potential causes of SNHL, but small diagnostic yield at present needs justification for contrast injection for this indication. Our findings suggest preferred referral from otolaryngologists exclusively, and implementation of a non-contrast MRI for SNHL may be a better diagnostic tool.

S210 – Asymmetric Sudden SNHL: Is All This Screening Necessary?

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P146-P146
Author(s):  
Selena E. Heman-Ackah ◽  
Dunn Ryan ◽  
Tina C. Huang
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Diagnostic Evaluation ◽  
Diagnostic Screening ◽  
Tertiary Care Facility

Objectives A number of factors have been identified that contribute to the presentation of asymmetric sudden sensorineural hearing loss (ASSNHL). Routinely patients presenting with ASSNHL undergo a battery of serologic testing and imaging in an attempt to determine a cause. The study will assess the utility of this diagnostic evaluation in elucidating a cause of an asymmetric sensorineural hearing loss. At the conclusion of this presentation, the participants should be able to: 1) Understand the utility of diagnostic screening in the management of ASSNHL. 2) Understand the cost-effectiveness of the diagnostic screening for ASSNHL. Methods The study design is a retrospective chart review. Charts from patients presenting to the otolaryngology clinic of a tertiary care facility between January 1, 2000, and November 30, 2007, with ASSNHL confirmed with audiometric evaluation were reviewed. Diagnostic tests included in the work-up of ASSNHL and test results were recorded. Percentage of positive tests was determined and compared to national data. Cost analysis of the diagnostic battery was performed. Results All patients presenting with sudden sensorineural hearing loss received 1 or more of the following serologic and radiographic tests: ANA, cholesterol, creatinine, DNA-ds, ESR, blood glucose, Lyme titer, rheumatoid factor, RPR, FTA-ABS, HSP, T3, TSH and MRI with gadolinium. The average cost associated with the full diagnostic evaluation is greater than $1,500. The positive rate for any of these tests was extremely low. Conclusions The utility of the comprehensive ASSNHL evaluation should be reconsidered. The choice of diagnostic evaluation should be directed by patient risk factors and exposures.

Hypertrophic Pachymeningitis of the Internal Auditory Canal: A Rare Case of Unilateral Sudden Sensorineural Hearing Loss

2018 ◽  
Vol 127 (9) ◽  
pp. 649-652 ◽  
Author(s):  
Thomas Muelleman ◽  
Hannah Kavookjian ◽  
James Lin ◽  
Hinrich Staecker
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Internal Auditory Canal ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
High Dose ◽  
Hypertrophic Pachymeningitis ◽  
Eighth Cranial Nerve ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri

Objectives: To describe and increase awareness of a rare cause of unilateral sudden sensorineural hearing loss. Methods: Case report and literature review. Results: We present a 66-year-old female who suffered left-sided sudden sensorineural hearing loss and dizziness. Diagnostic magnetic resonance imaging (MRI) did not reveal masses or lesions along the eighth cranial nerve or in the inner ear. Upon eventual referral to neurotology clinic, hypertrophic pachymeningitis of her left internal auditory canal and adjacent middle and posterior fossa dura were identified. The ensuing laboratory workup for autoimmune and infectious etiology revealed mild elevation of ACE 93 (9-67) but otherwise normal results. Conclusions: Idiopathic hypertrophic pachymeningitis is a diagnosis of exclusion. Neoplastic, infectious, and autoimmune causes must be ruled out. The prevailing treatment for this condition is high-dose corticosteroids. This entity should be considered when evaluating MRI scans obtained in the setting of sudden sensorineural hearing loss.

Hearing Improvement after Sudden Sensorineural Hearing Loss as a Predictor of Vestibular Schwannoma

ORL ◽  
2019 ◽  
Vol 82 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Omer J. Ungar ◽  
Anat Wengier ◽  
Oren Cavel ◽  
Ophir Handzel ◽  
Yahav Oron
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Vestibular Schwannoma ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Hearing Improvement

Sudden sensorineural hearing loss as a revealing symptom of vestibular schwannoma

2005 ◽  
Vol 125 (6) ◽  
pp. 592-595 ◽  
Author(s):  
Elisabeth Sauvaget ◽  
Sammy Kici ◽  
Romain Kania ◽  
Philippe Herman ◽  
Patrice Tran Ba Huy
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Vestibular Schwannoma ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing
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