Objectives/Hypothesis: Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) has recently been developed to detect high concentrations of protein or hemorrhage. We have previously reported that 50% of patients with sudden sensorineural hearing loss (SNHL) show high signals in the affected inner ear on 3D-FLAIR MRI. However, the relationship between 3D-FLAIR findings and hearing prognosis is unclear. Our objective was to evaluate the relationship between the results of 3D-FLAIR MRI at 3 Tesla and prognosis in sudden SNHL. Study Design and Methods: We used 3D-FLAIR at 3 Tesla with and without gadolinium enhancement to evaluate the pathologic conditions in the inner ears of 48 patients with sudden SNHL. Results: Thirty-one of 48 patients with sudden SNHL showed high signals in the affected inner ear on precontrast 3D-FLAIR. Hearing improvement in patients with high signals in the affected inner ear on precontrast 3D-FLAIR (25 ± 19 dB) was significantly worse than that in patients with no signal (45 ± 27 dB; P <.05). Our analysis suggests that high signals in the affected inner ear on precontrast 3D-FLAIR MRI is a new prognostic factor for sudden SNHL. Conclusions: 3D-FLAIR findings show that high signals in the cochlea on precontrast 3D-FLAIR are related to a poor hearing prognosis. These signals may reflect minor hemorrhage or an increased concentration of protein in the inner ear, which has passed through blood vessels with increased permeability or has originated in disrupted cells in the inner ear.
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