Sudden sensorineural hearing loss
Recommended: MRI Internal Auditory Canals with and without contrast is the preferred imaging study for sudden sensorineural hearing loss. Rule out vestibular schwannoma and demyelinating disease.
Recommended study
MRI Internal Auditory Canals with and without contrast
Rule out vestibular schwannoma and demyelinating disease. Begin oral or intratympanic steroids without waiting for imaging.
If the default doesn't apply
MRI contraindicated (pacemaker, severe claustrophobia)
Auditory brainstem response (ABR) screening
No contrast
Watch-outs
Time-sensitive steroid window
Steroid response declines after 2 weeks — start treatment empirically while awaiting imaging.
Pulsatile tinnitus or other neuro symptoms
Suggests an alternative diagnosis (DAVF, schwannoma growth) — broaden imaging.
Pearls
- Most SSNHL is idiopathic; only ~1-3% reveal vestibular schwannoma — but high enough yield to image all unilateral cases.
- Bilateral SSNHL is unusual — work up for autoimmune (Cogan syndrome), Susac syndrome, ototoxicity.
- Audiometry confirms sensorineural vs conductive — do not skip.