American College of Radiology
ACR Appropriateness Criteria®

Hearing Loss and/or Vertigo

Variant 1: Acquired conductive hearing loss in absence of clinically evident mass in the middle ear. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT temporal bone without IV contrast Usually appropriate ☢☢☢ 1-10 mSv 9 9 0 0 0 1 0 0 0 2 12
CT temporal bone with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 6 1 4 2 0 1 1 0 0
CT temporal bone without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 2 2 7 1 3 0 2 2 0 0 0
CT head without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 2 5 1 0 0 0 0 0
CTA head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 3 0 1 0 0 0 0
CT head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 1 1 0 0 0 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 0 1 0 0 0 0 0
MRA head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 10 2 3 0 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 1 3 0 0 0 0 0 0
MRI head and internal auditory canal without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 8 2 3 0 1 1 0 0 0
MRI head and internal auditory canal without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 8 2 4 0 0 0 0 1 0
MR venography head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 2 2 0 0 0 0 0 0
Variant 2: Acquired conductive hearing loss secondary to cholesteatoma or neoplasm with suspected intracranial or inner ear extension. Surgical planning.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT temporal bone without IV contrast Usually appropriate ☢☢☢ 1-10 mSv 9 9 0 0 0 1 0 0 2 0 12
References Study Quality
2 (19733309) 4
14 (26351038) 2
1 (26491893) 4
13 (23158050) 4
MRI head and internal auditory canal without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 1 0 0 1 0 2 3 8
References Study Quality
2 (19733309) 4
5 (27430449) 4
13 (23158050) 4
15 (22877955) 4
MRI head and internal auditory canal without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 1 10 1 0 1
References Study Quality
2 (19733309) 4
5 (27430449) 4
13 (23158050) 4
15 (22877955) 4
CTA head with IV contrast May be appropriate (Disagreement) ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 3 2 2 4 3 2 0 2 0 0
CT temporal bone with IV contrast May be appropriate ☢☢☢ 1-10 mSv 5 5 1 0 0 6 6 2 0 0 0
References Study Quality
2 (19733309) 4
14 (26351038) 2
1 (26491893) 4
13 (23158050) 4
CT temporal bone without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 6 1 3 1 2 1 1 0 0
References Study Quality
2 (19733309) 4
14 (26351038) 2
1 (26491893) 4
13 (23158050) 4
MRA head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 3 2 8 1 0 0 1 0 0
MRA head without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 6 1 3 2 2 1 0 0 0
MR venography head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 5 1 7 1 0 0 1 0 0
CT head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 2 3 2 0 1 0 0 1
CT head without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 2 4 0 0 1 1 0 0
MR venography head with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 1 7 3 2 0 0 2 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 3 1 0 1 2 0 0 0
Variant 3: Acquired sensorineural hearing loss. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head and internal auditory canal without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 2 11
MRI head and internal auditory canal without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 4 4 5
CT temporal bone without IV contrast May be appropriate ☢☢☢ 1-10 mSv 5 5 0 0 1 1 7 3 3 0 0
References Study Quality
2 (19733309) 4
16 (23713470) 3
13 (23158050) 4
CT temporal bone with IV contrast May be appropriate ☢☢☢ 1-10 mSv 4 4 3 3 1 1 5 2 0 0 0
CT head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 3 4 3 2 2 1 0 0 0
CT head without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 3 1 7 2 0 1 1 0 0
CT temporal bone without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 2 2 6 2 3 0 2 2 0 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 4 1 1 1 0 0 0
CTA head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 3 0 0 1 0 0 0
MRA head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 10 2 2 1 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 1 2 1 0 0 0 0 0
MR venography head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 1 2 1 0 0 0 0 0
MR venography head with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 1 1 0 0 0 0 0 0
Variant 4: Mixed conductive and sensorineural hearing loss. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT temporal bone without IV contrast Usually appropriate ☢☢☢ 1-10 mSv 9 9 0 0 1 0 1 0 0 1 12
MRI head and internal auditory canal without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 1 2 7 4
MRI head and internal auditory canal without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 2 4 6 1 1
CT temporal bone with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 4 1 4 2 3 1 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 6 1 4 1 2 1 0 0 0
CT head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 4 3 2 2 3 1 0 0 0
CT head without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 3 2 6 2 0 1 1 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 3 3 2 1 0 0 0 0
CTA head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 3 1 1 0 0 0 0
MRA head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 1 3 0 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 1 3 0 0 0 0 0 0
MR venography head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 1 3 0 0 0 0 0 0
MR venography head with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 2 0 0 0 0 0 0 0
Variant 5: Congenital hearing loss or total deafness or cochlear implant candidate. Surgical planning.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT temporal bone without IV contrast Usually appropriate ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 0 0 2 13
MRI head and internal auditory canal without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 2 4 5 3
MRI head and internal auditory canal without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 4 0 5 2 3
CT temporal bone with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 5 2 4 0 2 2 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 2 2 7 1 3 1 2 1 0 0 0
CTA head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 2 1 1 0 0 0 0
CT head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 8 2 5 0 0 0 0 0 0
CT head without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 0 5 0 0 0 0 1 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 5 0 0 0 0 0 0
MRA head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 2 2 0 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 2 2 0 0 0 0 0 0
MR venography head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 2 2 0 0 0 0 0 0
MR venography head with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 1 0 1 0 0 0 0 0
Variant 6: Episodic vertigo with or without associated hearing loss or aural fullness (peripheral vertigo). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT temporal bone without IV contrast Usually appropriate ☢☢☢ 1-10 mSv 8 8 0 0 1 0 0 0 1 6 7
MRI head and internal auditory canal without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 0 1 5 7
MRI head and internal auditory canal without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 2 1 5 5 1
CTA head and neck with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 1 4 5 2 2 0 0 0
MRA head and neck without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 1 2 3 5 2 2 0 0 0
CT temporal bone with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 5 2 3 1 2 2 0 0 0
CT head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 4 2 5 1 3 0 0 0 0
CT head without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 2 4 3 3 2 0 1 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 3 5 3 0 0 0 0 0
MRA head and neck without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 3 5 4 1 1 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 2 2 7 1 3 1 1 2 0 0 0
MR venography head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 7 1 3 0 2 1 0 1 0
MR venography head with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 10 2 3 0 0 0 0 0 0
Variant 7: Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head and internal auditory canal without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 2 12
MRI head and internal auditory canal without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 1 5 5 3
CT head without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 1 1 3 7 2 0 1
CTA head and neck with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 0 1 8 5 0 0
MRA head and neck without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 3 8 3 0 0
MRA head and neck without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 1 7 6 0 0
CT head with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 1 5 0 7 1 1 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 5 0 3 2 0 0 0
CT temporal bone without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 2 2 7 1 3 2 1 1 0 0 0
CT temporal bone with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 10 1 2 2 0 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 9 2 2 2 0 0 0 0 0
MR venography head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 8 3 2 1 1 0 0 0 0
MR venography head with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 10 3 1 0 1 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.