To image or not to image? A cost-effectiveness analysis of MRI for patients with asymmetric sensorineural hearing loss

Hojjat, Houmehr; Svider, Peter F.; Davoodian, Pedram; Hong, Robert S.; Folbe, Adam J.; Eloy, Jean Anderson; Shkoukani, Mahdi A.

doi:10.1002/lary.26231

Cited by 21 publications

(23 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Asymmetry can be based on the average interaural difference (ID) of specific audiometric frequencies or a frequency range, the value of the maximum difference in one or more frequencies, or a combination of characteristics. Many different approaches have been documented (Cahani et al, 1984, Caldera and Pearson, 2000, Cheng and Wareing, 2012, Hendrix et al, 1990, Hojjat et al, 2017, Jeffery et al, 2016, Mangham, 1991, Margolis and Saly, 2008, National Guideline Centre UK, 2018, Tsai et al, 2012, Urben et al, 1999. Examples from clinical practice also differ.…”

Section: Introductionmentioning

confidence: 99%

The spatial percept of tinnitus is associated with hearing asymmetry: Subgroup comparisons

Genitsaridi

Kypraios

Edvall

et al. 2021

Progress in Brain Research

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

The spatial percept of tinnitus is associated with hearing asymmetry: Subgroup comparisons

Genitsaridi

Kypraios

Edvall

et al. 2021

Progress in Brain Research

View full text Add to dashboard Cite

show abstract

“…Gadolinium-enhanced nuclear magnetic resonance imaging (MRI) is the current diagnostic gold standard for retrocochlear lesions [ 5 , 21 ]. However, because the number of MRI exams needed on this group of patients is very large, and the number of schwannomas found is very small, screening algorithms have been developed to preserve and maximize resources [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Multiple Audiometric Analysis in the Screening of Vestibular Schwannoma

Celis‐Aguilar¹,

Obeso-Pereda²,

Castro-Bórquez³

et al. 2022

Cureus

View full text Add to dashboard Cite

Introduction Asymmetric sensorineural hearing loss is the main early symptom of retrocochlear lesions, hence its importance in screening for vestibular schwannomas. Currently, there is no consensus regarding its definition. The objective was to identify the audiometric pattern that would serve as a predictor for vestibular schwannoma in patients with asymmetric hearing loss. Materials and methods A cross-sectional study was conducted that included patients with asymmetric hearing loss attending a secondary care center and a tertiary care center. Clinical, audiometric and imaging (MRI with gadolinium) variables were collected. Asymmetric hearing loss was defined as a difference of 15 dB in one or more frequencies between both ears. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of different audiometric patterns were analyzed. Results A total of 107 patients were studied and divided into two groups: group 1 without vestibular schwannoma (n=98); and group 2 with vestibular schwannoma (n=9). No significant difference in demographic characteristics or audiometric patterns was found in patients with and without vestibular schwannoma. The audiometric pattern with the best sensitivity as a screening test was a difference >20 dB in the 4,000 Hz frequency, with a sensitivity of 77.78%, specificity of 30.61%, PPV of 8.33%, NPV of 93.75% and accuracy of 34.50%. Conclusion The audiometric pattern with the best results was a difference >20 dB in the 4,000 Hz frequency range; however, patients with asymmetric hearing loss could not be differentiated from patients with retrocochlear lesions based only on audiometry. Asymmetrical hearing loss must be studied with MRI.

show abstract

“…About 40% of these otologists stated that medicolegal concerns were a significant factor in their decision to pursue imaging. 17 Many studies [18][19][20][21] have suggested a non-contrast MRI with a dedicated IAC protocol to be used as an initial screening test for patients with SNHL. Sequences like T2-weighted imaging and a steady-state free precession (brand names "FIESTA," "TrueFISP," and balanced FFE) provide higher spatial resolution and clearer depiction of tiny intracranial structures.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Yield of MRI for Sensorineural Hearing Loss – An Audit

Wong

Amoako-Tuffour

Faiz

et al. 2020

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

Purpose: Contrast-enhanced magnetic resonance imaging (CEMRI) of the head is frequently employed in investigations of sensorineural hearing loss (SNHL). The yield of these studies is perceptibly low and seemingly at odds with the aims of wise resource allocation and risk reduction within the Canadian healthcare system. The purpose of our study was to audit the use and diagnostic yield of CEMRI for the clinical indication of SNHL in our institution and to identify characteristics that may be leveraged to improve yield and optimize resource utilization. Materials and methods: The charts of 500 consecutive patients who underwent CEMRI of internal auditory canal for SNHL were categorized as cases with relevant positive findings on CEMRI and those without relevant findings. Demographics, presenting symptoms, interventions and responses, ordering physicians, and investigations performed prior to CEMRI testing were recorded. Chi-squared test and t-test were used to compare proportions and means, respectively. Results: CEMRI studies revealed relevant findings in 20 (6.2%) of 324 subjects meeting the inclusion criteria. Pre-CEMRI testing beyond audiometry was conducted in 35% of those with relevant positive findings compared to 7.3% of those without (p < 0.001). Auditory brainstem response/vestibular-evoked myogenic potentials were abnormal in 35% of those with relevant CEMRI findings compared to 6.3% of those without (p < 0.001). Conclusion: CEMRI is a valuable tool for assessing potential causes of SNHL, but small diagnostic yield at present needs justification for contrast injection for this indication. Our findings suggest preferred referral from otolaryngologists exclusively, and implementation of a non-contrast MRI for SNHL may be a better diagnostic tool.

show abstract

To image or not to image? A cost-effectiveness analysis of MRI for patients with asymmetric sensorineural hearing loss

Abstract: 2c. Laryngoscope, 127:939-944, 2017.

Cited by 21 publications

References 35 publications

The spatial percept of tinnitus is associated with hearing asymmetry: Subgroup comparisons

The spatial percept of tinnitus is associated with hearing asymmetry: Subgroup comparisons

Multiple Audiometric Analysis in the Screening of Vestibular Schwannoma

Diagnostic Yield of MRI for Sensorineural Hearing Loss – An Audit

Contact Info

Product

Resources

About