MRI-Based Inner Ear Assessment and Cochlin Tomoprotein-Based Evaluation of Perilymphatic Fistula in Patients with Sudden Hearing Loss

Abstract

Objectives: To study the correlation between positive cochlin tomoprotein testing (CTP), magnetic resonance (MR) imaging, and the auditory and vestibular function amongst patients with sudden hearing loss.

Study design: Prospective case series.

Methods: We prospectively examined eight patients who presented with sudden hearing loss (>60 dB) with or without vertigo or tinnitus. We performed an ELISA-based CTP detection test using middle ear lavage samples. In addition to the CTP examination, a magnetic resonance imaging (MRI) examination was performed using different sequences (T1 and a T1 sequence with a contrast medium (CM), a T2 sequence, 4 h delayed intravenous gadolinium-enhanced three-dimensional fluid-attenuated inversion recovery (3D FLAIR)).

Results: All patients with sudden hearing loss (>60 dB) presented a non-specific contrast enhancement in the cochlea and vestibulum on the affected side on delayed 3D-FLAIR MRI. Four patients had a positive CTP test, suggesting a perilymphatic fistula (PLF). However, no specific MRI signal for a PLF was observed.

Conclusions: Using multimodal diagnostic measures, such as CTP testing and different MRI sequences, no correlation could be found in patients with a PLF.

Keywords: 4 h delayed intravenous gadolinium-enhanced 3D FLAIR MRI; cochlin tomoprotein; magnetic resonance imaging; perilymphatic fistula; sudden hearing loss.

Figure 1

A 60-year-old male presented with a sudden hearing loss on the right side for one week. The axial 4 h delayed 3D FLAIR sequence shows a contrast enhancement in the cochlear basal turn (arrow) (A) and vestibulum (B). About 3/3 of fluid filling in the RW niche was observed (arrow, (C)).

Figure 2

A 38-year-old female presented with sudden hearing loss on the left side and acute rotatory vertigo. The axial 4 h delayed 3D FLAIR sequence shows a contrast enhancement in the left cochlea (A). A cochlear (arrow) and vestibular (dashed arrow) contrast enhancement was observed in the axial T1 sequence (B). Hypointense signal intensity in the basal turn of the left cochlea was found on axial T2W (C).

Figure 3

A 48-year-old male presented with a sudden hearing loss on the right side with tinnitus. The axial 4 h delayed 3D FLAIR sequence shows a contrast enhancement in the cochlea basal turn on the right side (A). In the same MR sequence, a vestibulum (arrow (B)) and fundus (dashed arrow (B)) and MR enhancement were observed, as well as an inversion of the saccule (arrow (C)) and utricle (dashed arrow (C)) area ratio.

Figure 4

An 86-year-old male presented with a sudden hearing loss on the left side without vertigo and tinnitus. On the axial 4 h delayed 3D FLAIR sequence, there was a contrast enhancement in the cochlea basal turn (arrow (A)) and vestibulum (arrow (B)) on the left side.

Figure 5

A 77-year-old patient with sudden hearing loss on the right side with rotatory vertigo. The contrast enhancement was seen in the right cochlea (A) and vestibulum (B) on the axial delayed postcontrast 3D-FLAIR sequences. In the axial CT image, a dehiscence in the right superior semicircular canal was detected (C), which could also be confirmed as a nodular contrast enhancement (array) in 4 h delayed 3D-FLAIR sequences (D). About 1/3 of the fluid filling in the RW niche was observed on the axial CT (E).

Figure 6

A 66-year-old male with a sudden hearing loss on the right side without vertigo or tinnitus. The contrast enhancement was seen in the right vestibulum and cochlea (array) with axial 4 h delayed 3D-FLAIR sequences.

Figure 7

An 84-year-old male presented with an acute hearing loss on the right side with rotatory vertigo. The contrast enhancement was seen in the right vestibulum and basal turn of the cochlea on the 4 h delayed 3D-FLAIR sequences.

Figure 8

An 85-year-old female presented with sudden hearing loss on the left side with rotatory vertigo. The contrast enhancement was seen in the left cochlea ((A) dashed arrow) on the axial 4 h delayed 3D-FLAIR sequences. The inversion of the saccule ((A) arrow) to the utricle ((B) arrow) area ratio was observed.