Improvement in Sudden Sensorineural Hearing Loss with Steroid Therapy Does Not Preclude the Need for MRI to Rule out Vestibular Schwannoma

Abstract

Background Sudden sensorineural hearing loss (SSNHL) is the presenting symptom of vestibular schwannoma (VS) in ∼10% of cases. In patients initially presenting with SSNHL, steroid therapy is often instituted immediately upon diagnosis of hearing loss, often before an MRI of the head has obtained to rule out retrocochlear causes. There is a common misconception that improvement in hearing after treatment with steroids effectively excludes the possibility of a VS and in such cases, an MRI is not indicated. The authors have encountered several patients who have had an initial delay in VS diagnosis as a result. Paralleling this, it is not uncommon that steroid therapy is withheld for SSNHL in patients with an existing diagnosis of VS, believing that this condition is not steroid responsive.