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The article entitled "Effectiveness of Treatment for Sudden Sensorineural Hearing Loss" by Eisenman and Arts,¹ and the responses by Tucci² and Hashisaki³ clearly outline the problems that we all have in managing cases of of sudden hearing loss (SHL). We are hampered mostly by a lack of information regarding the etiology of this disorder.

The authors commented on the value of a gadolinium-enhanced magnetic resonance imaging (MRI) scan only to "rule out a retrocochlear lesion." I would direct the authors and your readers to an article Mark and I published in 1998.⁴ We reviewed the records of 78 consecutive patients with sudden hearing loss and found abnormal gadolinium MRI results in 24 cases (31%). Most of the abnormal MRI results were due to enhancement of the inner ear—not acoustic neuromas. We also published an article in 1999 proving that viral infection of the inner ear could produce enhancement of the . . . [Full Text of this Article]