title: Vertigo and hearing loss.
abstract: Symptoms referable to disorders affecting the inner ear and vestibulocochlear nerve (eighth cranial nerve) include dizziness, vertigo, tinnitus, and hearing loss, in various combinations. Similar symptoms may occur with involvement of the central nervous system, principally the brainstem and cerebellum, to which the vestibular and auditory systems are connected. Imaging choices should be tailored to patient symptoms and the clinical context. Computed tomography (CT) should be used primarily to assess bony structures. Magnetic resonance imaging (MRI) should be used primarily to assess soft-tissue structures. Vascular imaging by angiography or venography should be obtained when vascular lesions are suspected. No imaging should be obtained in patients with typical presentations of common peripheral vestibular or auditory disorders. In current clinical practice, neuroimaging is often overused, especially CT in the assessment of acute dizziness and vertigo in the emergency department. Despite low sensitivity for ischemic strokes, CT is often used to rule out neurologic causes. When ischemic stroke is the principal concern in acute vestibular presentations, imaging should almost always be by MRI with diffusion-weighted images, rather than CT. In this chapter, we describe recommended strategies for audiovestibular imaging based on patient symptoms and signs.
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: toker@jhu.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Newman-Toker
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Della Santina
authors.affiliation: Neuro-radiology Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ari M
authors.initials: AM
authors.lastname: Blitz
mesh_terms: D034381:Hearing Loss / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D059906:Neuroimaging; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology; D014717:Vertigo / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: dizziness; hearing loss; neuroimaging; stroke; vertigo; vestibular diseases