Incidence of Retrocochlear Pathology Found on MRI in Patients With Non-Pulsatile Tinnitus.
OBJECTIVE
To identify the incidence of retrocochlear pathology on MRI in patients with non-pulsatile tinnitus.


METHODS
Retrospective review.


METHODS
Tertiary referral center.


METHODS
Adults with MRIs performed between March 1, 2008 and February 1, 2014 for non-pulsatile tinnitus with or without hearing loss.


METHODS
MRI.


METHODS
Incidence of retrocochlear pathology.


RESULTS
Of the 218 patients who met inclusion criteria, 198 (91.3%) had unremarkable MRIs. Six patients (2.7%) had MRI findings that accounted for their tinnitus. Of these patients, five had unilateral tinnitus with asymmetric hearing loss because of acoustic neuroma found on MRI. One patient presented with bilateral tinnitus with asymmetric hearing loss and was found to have a right acoustic neuroma. Twenty (9.2%) patients had bilateral or unilateral tinnitus without hearing loss, all with unremarkable MRIs. Fourteen patients (6.4%) had incidental findings including two acoustic neuromas that were identified contralateral to the side of presenting tinnitus.


CONCLUSIONS
Imaging should be used judiciously in the evaluation of tinnitus. Patients with unilateral tinnitus and asymmetric hearing loss were most likely to have abnormal findings. The majority of MRIs performed for tinnitus were normal in our study. Given the low incidence of MRI findings in the workup of tinnitus, every effort should be made to optimize screening protocols. Noncontrasted fast spin-echo T2-weighted MRI should be used to assess patients with tinnitus when there is low suspicion for retrocochlear pathology. Patients with unilateral non-pulsatile tinnitus with symmetric hearing may be observed, but clinical judgement should determine the need for further imaging.
Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, U.S.A.
Kevin J
KJ
Choi
Mirabelle B
MB
Sajisevi
Russel R
RR
Kahmke
David M
DM
Kaylie
D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007759:Labyrinth Diseases / Q000150:complications / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000453:epidemiology; D012189:Retrospective Studies; D014012:Tinnitus / Q000209:etiology* / Q000473:pathology