Inner ear hemorrhage : A cause of sensorineural hearing loss in leukemia

ABSTRACT

@#A 25-year-old male who was recently diagnosed with chronic myelogenous leukemia developed bilateral tinnitus and hearing loss. The hearing loss progressed rapidly but asymmetrically, with the right ear being subjectively worse than the left. Pneumatoscopy revealed bilaterally intact and mobile tympanic membranes and no visual evidence of middle ear pathology. Audiometry confirmed the presence of a profound hearing loss in the right ear and a moderate sensorineural hearing loss in the left ear. In relation to evaluating the cause of hearing loss, the radiologic interpretation of a contrast-enhanced cranial MRI performed to evaluate other neurological symptoms that predated the hearing loss only stated that the cerebellopontine angle cisterns were unremarkable. No mention was made about the status of the inner ears. When asked to comment on the inner ears in the MR study, the radiologist opined that the cranial MRI did not have the proper fine-cut imaging sequences necessary to evaluate this region adequately, and indicated the need for a dedicated MR study of the temporal bones. An independent review of the DICOM imaging data of the patient’s cranial MRI revealed the presence of three imaging sequences with information pertinent to the evaluation of the inner ears. These sequences are shown below, with a sequential narration of the descriptive imaging findings and their clinical significance that helps to arrive at a conclusive diagnosis.