Is Comprehensive ASNHL Screening Always Needed?

What are the costs and diagnostic yield of screening patients presenting with asymmetrical sensorineural hearing loss (ASNHL)?

Background: The magnitude of workup on a patient with ASNHL of an uncertain onset or chronic nature is a problem commonly encountered by otolaryngologists. The typical comprehensive workup includes a number of expensive tests, including a battery of serologic testing and radiographic imaging. Despite the extensive and costly testing available, the etiology of the ASNHL often remains unclear.

Study Design: Retrospective chart review

Setting: Patient charts from New York Eye and Ear Infirmary and University of Minnesota

Synopsis: Of 2,130 patient charts reviewed, 247 met the criteria, which included diagnostic imaging and serum laboratory values. Positive rate was determined for each diagnosis.

To estimate cost-benefits, the authors calculated the average cost for identifying a patient with a positive result. A total of 462 diagnostic tests were performed. The total lab cost was $18,276, compared to the total imaging cost of $246,600.

Of the 247 patients, only six (2.4 percent) were identified with treatable pathology. The image cost for identifying a positive patient was $61,650 based on MRI, compared to the lab cost of $1,142.

Bottom line: Due to the high cost and low yield of MRI among patients presenting with ASNHL, it should be reserved for those presenting with either a high index of suspicion based on clinical symptoms and findings or a serial audiogram showing progression of the ASNHL.

Citation: Wilson YL, Gandolfi MM, Ahn IE, et al. Cost analysis of asymmetric sensorineural hearing loss investigations. Laryngoscope. 2010;120(9):1832-1836.

—Reviewed by Sue Pondrom