MRIs are the gold standard for determining retrocochlear pathology in the setting of sudden deafness and ASNHL but are expensive. Approximately one-third of the respondents still use ABR and acoustic reflex testing as screening tools before ordering MRI. MRI typically have a low yield in finding an abnormality (usually <1%-4%). Neurotologists in our survey seem to recognize this quandary: they usually order an MRI, although they know it will usually be negative, and 40% of them cite medicolegal concerns as one of the motivations for their decision. This suggests that routine use of MRI partially reflects the practice of defensive medicine rather than medicine based on evidence. Perhaps MRIs are rarely indicated as the initial screening tool in ASNHL and sudden deafness, given their high cost and low yield of abnormal findings, and their routine use should and could be reduced to contain medical costs.

We present a case of bilateral otitisexterna that did not respond to local treatment. Cutaneous biopsies revealed bilateral amyloid depositions secondary to multiple myeloma. Persistent, identical bilateral canal lesions may be the only manifestation of treatable systemic disease and should be biopsied, even though theirbilaterality argues against malignancy.

Patients who present with an acute onset of unilateral sensorineural hearing loss with decreased speech discrimination may be mistakenly thought to have idiopathic sudden sensorineural hearing loss when, in fact, they may have an SOM-induced phenomenon that is potentially reversible. The distinguishing feature is a preexisting otitis media, which must be treated first, before the administration of steroids.

These findings are not consistent with the acclimatization first reported by Silman et al in 1993. Such a discrepancy in the results calls for further studies to evaluate just how effective unilateral hearing aids are in patients with bilateral symmetric sensorineural hearing loss.

These findings support our hypothesis and serve to inform the medical community (both ENT and primary care) that fluid is often present in the ME or mastoid in patients with acute OE whose symptoms will resolve with oral and/or topical antibiotics.