Imaging of Hearing Loss

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A wide range of pathology involving the external, middle, and inner ear contribute to conductive and sensorineural hearing loss. Diagnostic imaging plays a critical role in the evaluation and management of hearing loss. High resolution computed tomography (CT) of the temporal bone and magnetic resonance imaging (MRI) are the preferred imaging modalities to evaluate the ear structures for causes of hearing loss, with the specific type of hearing loss and location of defect dictating which type of imaging is preferred. In general, the external auditory canal, middle ear space, mastoid, petrous apex, and otic capsule are best visualized with CT, whereas suspicion of retrocochlear pathology warrants MRI.

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Imaging of hearing loss

Diagnostic imaging plays a critical role in the evaluation and management of hearing loss. The initial evaluation consists of obtaining a history that should address pertinent otologic information. The rapidity of onset, progressive nature, and presence of unilateral or bilateral symptoms influence the diagnostic possibilities. A history of trauma, otorrhea, pain, associated vertigo, exposure to noise or ototoxic medications, previous ear disease or surgery, and a family history of hearing loss

Imaging of conductive hearing loss

Conductive hearing loss (CHL) is most commonly caused by pathology of the external or middle ear and on occasion the inner ear. Sometimes the cause is obvious and imaging studies are not required before intervention. Imaging can be valuable in cases in which the cause is uncertain, however.

Imaging of sensorineural hearing loss

Imaging of sensorineural hearing loss is often unnecessary in symmetric downward sloping patterns consistent with presbycusis. Sudden or asymmetric sensorineural loss requires diagnostic imaging to evaluate for retrocochlear pathology, however. Recent advances in MR techniques have revealed findings in the inner ear in many of these patients also, potentially increasing the role of MRI in diagnosis of asymmetric and sudden hearing loss beyond identification of CPA masses.

Sudden sensorineural

Conductive hearing loss

Congenital conductive hearing loss may be caused by lateral chain fixation, ossicular malformation, congenital stapes fixation, aural atresia, oval or round window atresia, or a cochlear conductive loss attributable to inner ear anomaly. The imaging study of choice to evaluate for most of these entities is HRCT of the temporal bones, because most causes of congenital conductive hearing loss are due to bony anomalies within the middle or inner ear.

Congenital aural atresia is often associated

Summary

A wide range of pathologies involving the external, middle, and inner ear contribute to conductive and sensorineural hearing loss. HRCT of the temporal bone and MRI are the preferred imaging modalities to evaluate the ear structures for causes of hearing loss, with the specific type of hearing loss and location of defect dictating which type of imaging is preferred. In general, the external auditory canal, middle ear space, mastoid, petrous apex, and otic capsule are best visualized with CT,

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