A 48-year-old man reports two years of steadily worsening hearing loss in the left ear with constant ipsilateral tinnitus but no episodes of vertigo. Audiometry confirms an asymmetric sensorineural loss, and the stapedial reflex is absent on the affected side. The most appropriate next investigation is:

• A High-resolution CT scan of the temporal bone
• B Vestibular evoked myogenic potentials
• C Repeat pure tone audiometry after three months
• D MRI of the internal auditory canal with gadolinium contrast ✓

Explanation

Unilateral or markedly asymmetric sensorineural loss with tinnitus demands exclusion of a vestibular schwannoma, and contrast-enhanced MRI of the internal auditory canal is the gold standard, detecting tumours as small as 2 mm including intracanalicular ones. CT cannot reliably visualise small intracanalicular tumours and a normal scan gives dangerous false reassurance. Absent stapedial reflex points to a retrocochlear lesion, strengthening the need for imaging rather than watchful waiting.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.