Conte Giorgio, Di Berardino Federica, Mastrapasqua Rodolfo Francesco, Casale Silvia, Scola Elisa, Capaccio Pasquale, Triulzi Fabio, Pignataro Lorenzo, Zanetti Diego
Neuroradiology Department, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.
Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Audiol Neurootol. 2022;27(1):64-74. doi: 10.1159/000515153. Epub 2021 Apr 23.
Sudden sensorineural hearing loss (SSHL) is a relatively frequent disease, but a sensitive marker or a reliable test to identify the underlying cause is still unavailable. Neuroradiology appears to offer the most promising tools, especially magnetic resonance imaging (MRI). In a recent study from our group, we explored the ability of MRI to detect subtle changes in the inner ear compartments by means of a 3D-fluid-attenuated inversion recovery sequence, aiming at identifying 3 distinct MRI patterns (haemorrhagic, inflammatory, brain-labyrinth barrier breakdown). In the present study, we contrasted the MRI patterns at onset with relevant prognostic factors, with the audiological features of each patient's SSHL and with treatment outcomes.
In this retrospective study, we enrolled 50 adult subjects (54.61 ± 18.26 years) with SSHL. They underwent an MRI within 72 h from admission, and 5 audiological evaluations: at admission, on the 5th day after the start of medical therapy, at the end of the first cycle of hyperbaric oxygen therapy, then 1 and 6 months later.
Abnormalities of the MRI signal and/or post-contrast enhancement asymmetry of the cochlea ("pattern+ MRI") correlated with worse audiological outcomes at 1 month, but the different MRI patterns were not correlated with any specific prognostic model, despite rigid protocol settings. However, a significant difference was found for low-tone SSHL, which were always "pattern" negative at MRI (p = 0.01), and for profound SSHL which demonstrated a pattern+ MRI in 80% (p = 0.04). At the onset of SSHL, a pattern+ MRI was found in 29/50 cases (58.0%) and was related with lesser degree of recovery of pure-tone average at 1 month and lesser chance to retain the hearing threshold benefit in the long term. Given the limited numbers of patients enrolled so far, the relative impact of comorbidities on each MRI pattern remains uncertain. At 6 months, we observed a trend of greater and more stable recovery (p = 0.023) and less frequent recurrence of SSHL in patients with a normal MRI.
The 3 observed MRI patterns did not correlate consistently with specific audio-vestibular features or any peculiar aspect of the patient's clinical history. Larger series of patients with SSHL are needed, possibly from multicentric studies.
突发性感音神经性听力损失（SSHL）是一种相对常见的疾病，但目前仍缺乏用于识别潜在病因的敏感标志物或可靠检测方法。神经放射学似乎提供了最有前景的工具，尤其是磁共振成像（MRI）。在我们团队最近的一项研究中，我们通过三维液体衰减反转恢复序列探讨了MRI检测内耳腔细微变化的能力，旨在识别三种不同的MRI模式（出血性、炎症性、脑-迷路屏障破坏）。在本研究中，我们将发病时的MRI模式与相关预后因素、每位患者SSHL的听力学特征以及治疗结果进行了对比。
在这项回顾性研究中，我们纳入了50名成年SSHL患者（年龄54.61±18.26岁）。他们在入院后72小时内接受了MRI检查，并进行了5次听力学评估：入院时、开始药物治疗后第5天、高压氧治疗第一个周期结束时、以及之后1个月和6个月时。
耳蜗的MRI信号异常和/或增强后不对称（“模式+MRI”）与1个月时较差的听力学结果相关，但尽管有严格的方案设置，不同的MRI模式与任何特定的预后模型均无关联。然而，发现低音调SSHL存在显著差异，其MRI检查始终为“模式”阴性（p=0.01），而重度SSHL在MRI检查中80%表现为模式+MRI（p=0.04）。在SSHL发病时，50例中有29例（58.0%）发现模式+MRI，这与1个月时纯音平均恢复程度较低以及长期保留听力阈值益处的机会较小有关。鉴于目前纳入的患者数量有限，合并症对每种MRI模式的相对影响仍不确定。在6个月时，我们观察到MRI正常的患者有更大且更稳定的恢复趋势（p=0.023），SSHL复发频率更低。
观察到的三种MRI模式与特定的听-前庭特征或患者临床病史的任何特殊方面均无一致关联。需要更多SSHL患者的大样本研究，可能来自多中心研究。
