Asymmetric Sensorineural Hearing Loss in a Community‐Based Population

Abstract

Asymmetric sensorineural hearing loss (ASNHL) is fairly common, but it can be an indication of retrocochlear pathology. The incidence of acoustic neuroma (AN) has been estimated at 1/100,000; however, the incidence of AN in patients with ASNHL is unknown. The limitation of health care resources challenges otolaryngologists to develop reasonable cost-containment guidelines for the evaluation of patients with ASNHL for the presence of retrocochlear pathology. A 5-year (1990 to 1994) retrospective study of all patients with ASNHL who were evaluated in a community-based general otolaryngology practice was performed. Demographic, historic, and audiologic data and results from ABRs and radiologic studies were summarized. ASNHL was present in 325 patients. Auditory brain stem response tests were performed in 179 patients (55%), and 92% (164 of 179) were normal. Patients with abnormal or inconclusive auditory brain stem responses and patients with severe SNHL were evaluated with radiologic studies (46 patients). Among the 193 patients who had diagnostic studies, 4 were found to have ANs, for a prevalence of 2.1%. The charge of diagnosis per AN was more than $41,000. In summary, a small percentage of patients with ASNHL have retrocochlear pathology, and the charge of diagnosis per AN can be excessive. A cost-containment approach for the evaluation and management of patients with ASNHL is proposed.

Presbycusis phenotypes form a heterogeneous continuum when ordered by degree and configuration of hearing loss

“…The frequency of Between-ear PTT Asymmetry shows some agreement with the frequency of the L≠R classification; however, they may capture different aspects of Between-ear Asymmetric hearing loss. The common clinical definition of asymmetric hearing loss is that at least one frequency has PTT that differ between the ears by 15 dB or more (Urben et al, 1999). This is a rather liberal definition, and we note that when using the criteria of Demeester et al (2009) instead, the prevalence of asymmetry in our data is similar to theirs.…”

Silent Vestibulopathy in Asymmetric Hearing Loss Can Be a Sign of a Cerebellopontine Angle Tumor

“…While CPA tumors need to be ruled in adults presenting with asymmetric SNHL, this is not common; nor is the case in pediatric asymmetric hearing loss, in which cochlear nerve aplasia, congenital CMV and cochleovestibular anomalies predominate as the etiology in this type of hearing loss. Therefore, the incidence of CPA tumors in patients with ASNHL varies widely from 2.1% to 7.7%, depending on the definition of ASNHL [22,23]. In this study, to take into account all of the different definitions used in previous studies [17,[22][23][24][25], ASNHL was defined as a 15 dB difference at any single frequency or a 15% difference in SDS between ears.…”

“…Therefore, the incidence of CPA tumors in patients with ASNHL varies widely from 2.1% to 7.7%, depending on the definition of ASNHL [22,23]. In this study, to take into account all of the different definitions used in previous studies [17,[22][23][24][25], ASNHL was defined as a 15 dB difference at any single frequency or a 15% difference in SDS between ears. As our current study was retrospective, the smaller asymmetries for defining ASNHL do not imply less strict criteria for undergoing MRI.…”

Medicolegal Concerns Among Neurotologists in Ordering MRIs for Idiopathic Sensorineural Hearing Loss and Asymmetric Sensorineural Hearing Loss

“…Between 2% and 8% of people with ASNHL are found to have an enhancing retrocochlear lesion on magnetic resonance imaging (MRI) (4,5). Therefore, between 92% and 98% of MRI scans in those patients with hearing loss are negative for tumors.…”