Best of five
- A. Repeat pure-tone audiometry in five years
- B. CT temporal bones as the first test
- C. MRI of the internal auditory meati
- D. Carotid Doppler ultrasound
- E. No imaging because speech discrimination is preserved
FRCS (ORL-HNS) · SECTION 1 SBA
Asymmetric sensorineural hearing loss
A 56-year-old has progressive left-sided hearing difficulty and tinnitus. Audiometry shows a 20 dB asymmetry at two adjacent frequencies; there is no facial weakness. Which investigation is most appropriate?
C. MRI of the internal auditory meati
NICE advises considering MRI for sensorineural hearing loss with at least 15 dB asymmetry at any two adjacent test frequencies, even without localising signs.
Why every option is right or wrong
A. Repeat pure-tone audiometry in five years: The current asymmetry meets a threshold for retrocochlear investigation.
B. CT temporal bones as the first test: CT is useful for bony anatomy but is not the preferred screening test for vestibular schwannoma/CPA pathology.
C. MRI of the internal auditory meati: NICE advises considering MRI for sensorineural hearing loss with at least 15 dB asymmetry at any two adjacent test frequencies, even without localising signs.
D. Carotid Doppler ultrasound: This does not assess the internal auditory canals or CPA.
E. No imaging because speech discrimination is preserved: Preserved speech discrimination does not exclude retrocochlear pathology.
What if the scenario changed?
If there were ipsilateral facial weakness, NICE recommends MRI irrespective of pure-tone thresholds.
Draft Clinora educational material only; not official JCIE content, an accredited programme, or a substitute for local policy and specialist judgement.
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