University of California Irvine Orange, California
Objective: To compare white matter hyperintensities (WMHs) on T2-weighted magnetic resonance imaging (MRI) of patients with sudden sensorineural hearing loss (SSNHL) with an age-matched control group.
Methods: T2-weighted MRI scans of 150 patients with SSNHL were assessed for WMHs and compared with the data ofv 150 healthy age-matched adults. Assessments of WMHs included independent grading of deep white matter hyperintensities (DWMHs) and periventricular hyperintensities (PVHs). WMH severity was visually rated using Fazekas and Mirsen scales by two observers independently.
Results: Fazekas grades for PVHs (p < 0.001) and DWMHs (p < 0.001) of SSNHL patients were found to be significantly greater than those of healthy participants. The average Mirsen grades for DWMHs of healthy and SSNHL patients wereevaluated to be 0.373 ± 0.550 and 2.140 ± 0.859, respectively. Mirsen grades for DWMHs of SSNHL patients were found to be significantly greater (p < 0.001) than those of healthy participants. The Mirsen scale was found to have higher sensitivity (p < 0.001) than the Fazekas scale in grading PVHs and DWMHs. No significant difference (p = 0.24) was found in specificities between the two scales.
Conclusions: Patients with sudden hearing loss have a much higher likelihood of having periventricular and deep white matter hyperintensities compared to age-matched controls. These findings indicate that sudden hearing loss patients are more likely to have microvascular changes in the brain, which may indicate a vascular origin to sudden sensorineuralhearing loss.
Define Professional Practice Gap & Educational Need: The pathophysiology and management of SSNHL has remained subject of debate. Further investigation into discovering new and improved management solutions for better treating SSNHL has been called. For this reason, a need to educate otolaryngologists on new hypotheses for SSNHL etiology leading to new treatment strategies is warranted.
Learning Objective: To propose a new vascular etiology in SSNHL patients to ANS members which can relate this entity with other complex neurovascular disorders such as migraine. This can imply that SSNHL may have an underlying vascular or neurogenic inflammation pathophysiology similar to migraine offering new treatment strategies for SSNHL.
Desired Result: Informing neurotologists of a possible new pathophysiology for SSNHL that can be a stepstone for future treatment options in patients with SSNHL.
Level of Evidence - III
Indicate IRB or IACUC: The study has IRB approval from the UC Irvine