The Value Of Head MRI In The Diagnosis Of Patients With Sudden Deafness As The First Symptom

Objective:Sudden sensorineural hearing loss is one of the common emergency of ENT,the incidence of sudden deafness in China is in an upward trend in recent years.The etiology of sudden deafness could be found in only 10% to 15% patients surveyed by epidemiology.Considering some intracranial lesions,such as central vascular disease,central nervous system tumors,demyelinating lesions,ect.These patients sometimes appeared with a single symptom,and often see an ENT doctor with sudden hearing loss at first.For the detection rate is not that high,which resulted in these patients diagnosed of sudden sensorineural hearing loss by some doctors without any attention.In clinical work,many abnormal changes in the intracranial are found by head MRI examination.Taking into account the single symptom or delayed symptom,as well as the limitation of ABR,OAE in the diagnosis of intracranial lesions,for instance,it’s hard to find smaller tumors,and part of the cerebral infarction,cerebral hemorrhage.Usually,the development of such diseases,is rapid and high degree of malignancy,so it’s necessary to identify the importance of head MRI examination in the identification of malignant events.Methods:Respectively analyzing 233 patients(247 ears)with sudden deafness as the first diagnosis,who were enrolled in the Department of Otorhinolaryngology,the First Clinical Medical College of Shanxi Medical University during January 2013 to September2015,who had the examination of auditory brainstem response,distortion product otoacoustic emissions,pure tone test,as well as brain MRI+DWI+MRA.And they were all diagnosed of sudden sensorineural hearing loss at fist by the audiological examination,however,the brain MRI found some abnormalities associated with the cause of sudden deafness.Results:1.There were 233 patients,and 222 of them were diagnosed of "sudden deafness" by audiological tests,of whom the average age was(48.22 ± 15.72)years old,and 208 cases were with unilateral lesion and 14 cases were bilateral,as well as,21 cases were accompanied with diabetes accounting for 9.46%,47 cases with hypertension accounting for 21.17%.Their head MRI examination displayed intracranial lacunar infarction,cerebral vascular abnormalities and intracranial space-occupying lesion such as arachnoidal cyst in cerebellomedullary cistern,tonsillar herniation,sphenoid ridge meningioma.11 lesions related to sudden deafness were founded by the head MRI examination,about 4.7% of all and their age ranged from 32 to 78 years old with the mean of(54.64 ± 15.37).4 cases were suffering from hypertension,2 cases from diabetes.ABR abnormalities were in 6 cases.There were bilateral cerebellar hemispheric hemorrhage in 1 case,subacute cerebral infarction in 2 cases,cerebellopontine angle tumor in 5 cases,cerebellar tonsillar hernia in1 case,temporal arachnoid cyst 1 case,as well as a arachnoidal cyst in cerebellomedullary cistern during pregnancy.2.There were 9 cases with hearing loss raging from sever to total deafness,accounting for 81.82%.According to ABR examination,3 cases of CPA area occupied did not draw out all the waves,1 case of CPA area occupied did not draw the I wave,as well as,1 case of ventricle infarct and 1 case of cerebellar tonsillar herniation only drew out the Ⅴ wave,and the rest of the other cases were all in the normal range,the abnormal rate was 54.55%;By OAE examination,most of the frequency could be drawn out.Conclusion:1.Audiological examination could easily lead to misdiagnosis about central lesions when diagnosing sudden deafness,however,brain MRI could distinguish intracranial diseases,including occupying,bleeding,infarction,etc,which could make up for the shortage of audiological examination,and possess the advantages and specialties in timely finding the pathogenesis.2.In some lesions which damaged auditory pathway,especially from low to high auditory center,head MRI examination had more advantages than the audiologicalexamination,such as cerebral cortex auditory central lesions.3.MRI examination should be carried out when came cross with older,patients accompanied with diabetes,hypertension and other underlying diseases,what’s more,patients with severe hearing loss,ABR prompting retrocochlear diseases should promptly underwent MRI examination,for MRI examination had its character in identifying the etiology and excluding intracranial lesions.4.From the corelated studies,the value of combination of MRI examination and audiological examination when distinguishing etiology was of great significance.