Can an MRI miss an acoustic neuroma?

[ScoobyDoo]

Hello,

Back in 2005, I went for a hearing test as my hearing was getting pretty bad.  I had suffered a loud blast into my ear and it was never the same after that.  Due to the significant difference in hearing levels between my two ears, I was sent for an MRI.  It came back negative.

Today I went for hearing test with a new audiologist.  I took the copy of the letter from the ENT regarding the MRI.  Anyway, my test was done and when we went into the office to go over the results, the first thing the audiologist said to me "if you hadn't told me you'd had an MRI, I would be concerned.  Your audiogram is exactly like you would see with a tumour."  At any rate, something to those words.  He also asked if I had an older audiogram, which, unfortunately, I don't.  He said that with a sound trauma to the ear, he wouldn't expect to see the hearing worsen to any significant amount over a couple of years.  He also said that MRI's are pretty good to pick up anything.

My test showed virtually no hearing over 3000 Hz.  He says my ear is now dead in this region and with a new hearing aid, he wouldn't even try to amplify this region because there's "nothing there anymore".  The numbers from the test are below:

Frequency : left, right

0250: 10,40
0500: 10,40
0750: 10,50
1000: 10,55
1500: 10,65
2000: 15,75
3000: 20,100
4000: 20,120
6000: 20,n/a
8000: 25,120

There was no hearing at 6000 Hz in my right ear and he said it was dead in this range. The 4000 & 6000 Hz results were at the very bottom of the graph. At 6000 I only heard a "whoosh" which he said indicated adjacent areas in the ear were picking it up.


I don't remember those upper numbers being that low, but I'm only going from memory.  I seem to recall that they were between 80 dB and 90 dB above 3000 Hz, but I could easily be mistaken.

Now, onto my question. 

Is it possible that the MRI missed something?  This was a straight MRI, with no contrasting agent used.  Could it have been so small that it wasn't visible, but over the past 3 years it's grown in size?  From the audiologists reaction this morning, and thinking that perhaps my upper frequency has really gone, I am wondering.  Overall, I think everything is worse - I know that my low-frequency hearing wasn't quite that bad, but it wasn't perfect either.

Any thoughts about this?  It could be a bad memory from what I'm thinking the audiogram said in 2005, or perhaps my hearing in the upper frequency ranges have gotten really bad.

Should I be concerned, going for another MRI, or just thinking it's likely nothing since the first MRI showed nothing.

Thanks!

[nancyann]

Hi there ScoobyDoo (LOVE YOUR NAME ! !)

It sounds to me this is a 'mechanical' hearing issue;
however,  I would ask for an MRI with contrast,  just to be on the safe side.

[Dan]

Hello,

My radiologist always does (3 time now) a small MRI without and then the full skull MRI with contrast and he said without he would miss alot of the smaller ANs.  My last MRI 1 year postop he said with contrast he sees something 3mm in size without nothing,  it could be just scar tissue from the OP.  With contrast they can see very small ANs.  Hope yours isn't an AN but they should do the MRI with contrast.

Dan in Germany

[Jim Scott]

Scooby:

I'm not really knowledgeable when it comes to audiology (I've never had a hearing test) but I have had numerous MRI scans over the past few years.  Although your hearing loss may be related to the noise trauma you suffered some years ago, because of the unilateral hearing loss and the fact that your last MRI was taken 4 years ago and without the gadolinium dye for contrast, I would suggest that you may want to consider undergoing a 'fresh' MRI scan - with contrast - to determine whether or not you might actually have an acoustic neuroma.  I hope that isn't the case but you may as well settle the issue once and for all.  A 45-minute MRI scan could do that. 

Jim

[ScoobyDoo]

Hi, and thanks for the messages!

I doubt that it is an AN.  However, it would be nice to know "for sure" since now I'm wondering if they did miss something.  I'll talk to the audiologist on Monday after we compare the next hearing test with the one in 2005 and see what he recommends.

Unfortunately, no matter what, my hearing is shot in my right ear.  Before I spend a lot of money on another hearing aid, I want to make sure I know exactly what's going on with it.

Thanks again.  I appreciate all your thoughts and input.  If you think of anything else, please let me know!

Now I think I have to do some reading in the tinnitus section.  It gets annoying, doesn't it!

[Tumbleweed]

ScoobyDoo:

Not only are MRIs taken with contrast more revealing than those taken without, but also some equipment is superior to others. That is, you might get a clearer picture of an AN with one MRI machine than with another. The other thing is that, although MRIs usually show an AN, the radiologist might miss it if they're looking for a lesion in another part of the brain.

Case in point: The radiologist who read my last MRI, taken at Stanford, noticed a "new" lesion in my hypoglossal canal. However, when Dr. Chang compared that MRI to one taken seven months earlier at a different facility, the hypoglossal tumor could be seen on that earlier MRI, too—it had simply been overlooked at the time, in part because the image wasn't as clear.

On the other hand, I have a friend who suddenly had severe unilateral hearing loss (overnight). A subsequent MRI taken at Stanford revealed no tumors.

The only way for you to know for sure is to get another MRI, with contrast, taken at a facility that has the equipment and staff capable of imaging and interpreting the films for acoustic neuroma.

Best wishes,
Tumbleweed

[ScoobyDoo]

I did a scan (although not the best one) of my audiogram chart.

There certainly is quite a difference between the two.  The left is within the normal range.  I thought that my right ear went down to 90 dB at 6000 Hz, but I'll find out when I visit the audiologist who did my last test in 2005, on Monday.

I suspect what will happen is that I discover my memory isn't that good, and there isn't much difference.  I do know that there was never any range that had no hearing.

I guess what's got me thinking is when the audiologist on Thursday said that my audiogrma says "tumour", and that if the hearing loss is caused by acoustic trauma, then it won't decrease over time.  Well, time will tell!

[nancyann]

Hi there Scooby,  My hearing chart looked the same as yours,  actually,  I think my AN ear dropped down quicker then yours.
Nevertheless,  just to be on the safe side,  please go ahead & get an MRI with contrast.

Always  good thoughts,  Nancy

[mrgarlic]

Hello Scooby, I need to also tell you that there really is a major difference in MRI's. Ask for a( 3.0  thin slice with contrast ) It will cost more but it will show all. We all want you to find the answers. There is even a good feeling to know for sure there is a tumor. Now at least you will have a good diagnosis and can get proper treatment,,,,,,,,,,,,,,,,Larry

[ScoobyDoo]

Thanks so much, everyone, for your kind words and wishes.  I do hope that I'm one of those who zip in, then zip out never to be heard from again.  No offense, but membership in your club has a big price tag!  Not that you're not all very nice here, you are, but I think you understand. 

Seriously, your words have made me feel better.  I was concerned back in 2005, and wondered why they wouldn't give me contrast then.  They wouldn't.  This time I'm going to insist on it every step of the way.  I did find a document that discusses the process and contrast vs non-contrast.  I haven't read it all, but if I'm allowed to post a link, it's here:
 http://bjr.birjournals.org/cgi/reprint/73/867/242.pdf

I know what you mean, mrgarlic.  If I had the test and it came back positive, there would be some relief that I finally knew what was going on.  Not that I want that result, but I've spent the past 4 years with it in the back of my mind, and having my hearing, tinnitus and some vertigo get worse.  I noticed an incredible difference in my hearing.  My audiogram shows what I've been feeling.  I do wonder if they did miss something as my symptoms tend to point this way.  However, if I have a good MRI done with contrast and it shows nothing, then I think I'll also feel relief that I know it's not an AN with a good level of confidence.

I go tomorrow morning at 1030 for a test at a different audiologist.  He's the one that suggested the MRI in the first place back in 2005.  I hope he still has a copy of the audiogram from then so that we can compare it.  I'm also going to discuss all this with him and see what his recommendation is.  In the end, I do want an MRI with contrast one way or another, just to either put my mind at ease, or deal with what's there.

I also have to say I've seen an incredible amount of courage from the people who have taken out membership here.  A lot of trials, pain and suffering, but a great deal of courage and a lot of human spirit!  It's very moving!

I'll post more tomorrow after my test.

[RichardS]

Hi ScoobyDoo
Thanks for the link to that article - it was very useful. Like you I have had one negative scan without contrast, and I am wondering whether something was missed, given my current symptoms. I am seeing the ENT in a fortnight, so I am going to take your article along to beat him up with.
Thanks again
Richard

[ScoobyDoo]

Hello everyone!

I just got back from the audiologist.  This is the same audiologist who recommended the MRI back in 2005 because my symptoms were similar to an AN.

He did the test today and compared it to the 2005 audiogram.  My left ear has changed little, if any.  It's still quite normal and unremarkable.  My right ear has had considerable change since 2005.  The lowest level of hearing impairment was 80 dB and this is now down to 120 dB.  The drop has been significant in every hearing range.

At this point, he won't even discuss a hearing aid.  He is referring me to the ENT for an MRI scan.  I was going to do this anyway, but it's nice to see that he is thinking along the same lines.  He says that it is a very unusual situation, with the unilateral hearing loss becoming much worse over 4 years.  He says that there is definitely something going on in the ear.  While his suspicion is AN, he says it could be a number of items, such as a vascular problem in the inner ear.  However, he says that it's imperative to get it checked out, and says that one MRI showing negative results doesn't mean anything.

Of course, this is the exact same advice I was given here!  I am impressed with this audiologist.  The one I went to Thursday gave me quotes on hearing aids.  This one is not satisfied to have a report from 4 years ago saying it was negative.  That's impressive in my mind.  He won't proceed further with me until the results are in, stating that there's little use in me buying a hearing aid from him now until I know what the root cause of my hearing loss is.

So, the referral is in and I have to wait to hear from my ENT.  I know it can be a bit of a wait here to get in, and then around an 8 week wait for an MRI, so I think I'm in a waiting pattern for a bit.  I'm going to pester them, though, to see how fast they can get me in.

I'll let you know.

I, too know that there is something seriously wrong in my ear.  It may be an AN or it may not, but something, somewhere isn't right.  And at the rate I'm going, I'll be completely deaf in this ear in another few years.

Thanks for your kind words and support.  I may not be joining you in your group, but we'll see!

[suboo73]

Hi ScoobyDoo! 

Sounds like you are on your way to finding some answers to your questions.
Good luck with the next MRI!

Keep us posted.

Sue

[nancyann]

Hi Scoobydoo:  Putting out positive thoughts for a negative MRI (with contrast).
Please keep in contact & let us all know how things turn out.   

Always good thoughts,   Nancy

[sgerrard]

Thanks for your kind words and support.  I may not be joining you in your group, but we'll see!

Hi ScoobyDoo:

I think you already have joined.

You will not be the first non-AN patient to wind up here, if that is how it turns out. The broader scope of membership is "any one with strange head symptoms," so you are sure to fit right in. We got facial neuromas and trigeminal neuromas and meningiomas and Meniere's and some indeterminate diagnoses, and a few with two or three things going on. Unilateral hearing loss is more than enough to qualify you.

Seriously, welcome, and we could use someone named ScoobyDoo, so hang around if you want to. Glad to hear you are on track for a "real" MRI.

Steve