What is the best imaging modality for diagnosing a large vestibular aqueduct?

BACKGROUND A large vestibular aqueduct (LVA) is the most common inner ear anomaly found on the imaging evaluation of children with sensorineural hearing loss (SNHL). It is frequently associated with syndromic and nonsyndromic forms of SNHL or as an isolated finding. Large vestibular aqueduct syndrome can be characterized by delayed-onset, fluctuating, asymmetric, unilateral or bilateral SNHL or mixed hearing loss. Knowledge of an LVA is useful for practitioners to counsel their patients on avoiding contact sports or other activities with risk of head trauma. Others use the diagnosis to prompt testing for mutations in the EYA and PDS genes, looking for associated conditions such as Pendred syndrome. Currently there is debate between the best initial imaging modality to use when evaluating patients who have passed the newborn hearing screen but are presenting with idiopathic delayed-onset SNHL and are suspected of having an LVA.