American Board of Family Medicine (ABFM) Practice Exam

A 54-year-old male presents with hearing loss and tinnitus. Which additional characteristic indicates the need for an MRI of the brain?

1. A rapid onset of symptoms

2. Unilateral symptoms

3. Association with pain and otorrhea

4. Exposure to loud noise shortly before symptoms

The correct answer is: Unilateral symptoms

In the context of hearing loss and tinnitus, the presence of unilateral symptoms is particularly concerning for certain pathologies, such as vestibular schwannoma (acoustic neuroma) or other intracranial lesions. These tumors often present with asymmetric sensorineural hearing loss and can lead to additional neurological signs or symptoms over time, necessitating imaging to rule out significant underlying conditions. When a patient presents with unilateral hearing loss and tinnitus, it raises the suspicion of a possible lesion affecting the auditory pathway or structures related to balance and hearing, which is why an MRI of the brain is warranted. This imaging helps in visualizing any masses or abnormalities that could be causing the symptoms. Rapid onset of symptoms might suggest a more acute process that could need immediate intervention, but it is not specific enough to necessitate an MRI. Similarly, the presence of pain and otorrhea could indicate an ear infection or other otologic issues rather than central nervous system involvement. Finally, previous exposure to loud noise may lead to temporary hearing issues or noise-induced hearing loss, but it doesn't necessitate an MRI unless accompanied by unilateral symptoms. Thus, the emphasis on unilateral symptoms directly correlates with a higher risk of serious underlying conditions, making it the key factor for further imaging evaluation