OBJECTIVE: This study aimed to determine the predictive factors of abnormal MRI findings in patients with asymmetrical sensorineural hearing loss (ASNHL). STUDY DESIGN: A retrospective review of medical records. SETTING: A tertiary care hospital. METHODS: Patients with asymmetries of ≥10 dB in at least 1 frequency, who underwent an MRI study of the temporal bone or brain during 2019-2021, were included. Age, sex, clinical symptoms, past medical history, and audiometric parameters, including pure tone thresholds, speech reception thresholds, and speech discrimination scores, were retrieved from the electronic database. The MRI findings reported by radiologists were reviewed and extracted. RESULTS: Of 390 patients, 50 (12.8%) patients had relevant abnormal MRI findings that could explain ASNHL. The most prevalent abnormal MRI finding was an internal acoustic canal (IAC) or cerebellopontine angle (CPA) tumor (n = 38
76.0%), with other notable abnormalities including labyrinthitis, stroke, mucocele, and epidermoid. Multiple logistic regression analysis highlighted that hearing asymmetry of 15 dB at 1000 Hz (OR = 4.8
95% CI 2.2-10.5) was a significant variable. The proposed predictor demonstrated 84% sensitivity and 48% specificity in detecting abnormal MRI findings. CONCLUSION: A hearing asymmetry of 15 dB at 1000 Hz was an important clinical predictor of abnormal MRI findings in patients with ASNHL. This finding has the potential to serve as a referral guide for further MRI investigations. LEVEL OF EVIDENCE: 3 Laryngoscope, 135:1155-1160, 2025.