Magnetic resonance imaging in the evaluation of patients with sensorineural hearing loss caused by meningitis: implications for cochlear implantation.

OBJECTIVES

To determine the role of MRI in the evaluation of patients with sensorineural hearing loss (SNHL) caused by meningitis. Gadolinium-enhanced T1-weighted MRI (GdMRI) and 3D heavily weighted T2-weighted MRI (T2MRI) were associated with the occurrence of SNHL and the peroperative surgical findings during cochlear implantation, respectively.

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary referral otology and cochlear implant center.

PATIENTS

Seventeen patients who developed SNHL after bacterial meningitis were evaluated with MRI. Twenty-one cochlear implantations were performed in 11 patients with severe bilateral SNHL. Six patients developed unilateral SNHL and did not receive a CI.

INTERVENTIONS

MRI scans were independently scored by 3 observers. Sensitivity, specificity, positive predictive value, negative predictive value, and interobserver reproducibility were calculated.

RESULTS

Cochlea enhancement on GdMRI was present in 87% of the ears affected by SNHL. In patients with unilateral SNHL, a nonenhancing cochlea predicted the preservation of hearing on the ipsilateral side. In all cases with an incomplete electrode insertion (6/21), loss of cochlear patency was already seen on T2MRI. However, loss of fluid was also found in 29% of the cases in which full electrode insertion was achieved.

CONCLUSION

MRI is crucial for decision making in patients with SNHL after meningitis. Diminished cochlear patency, as seen on T2MRI, is related to electrode insertion difficulty but does not always preclude full electrode insertion in cochlear implantation. Cochlear enhancement on GdMRI is associated with the occurrence of SNHL.