Asymmetric Hearing Loss Prompting MRI Referral in a Military Population: Redefining Audiometric Criteria. (6th February 2018)

• Record Type: Journal Article
• Authors: Tolisano, Anthony M.; Burgos, Ricardo M.; Lustik, Michael B.; Mitchell, Lex A.; Littlefield, Philip D.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 158:Number 4(2018)
• Page Start: 695
• Page End: 701
• Publication Date: 2018-02-06
• Subjects: asymmetric hearing loss -- retrocochlear tumor -- magnetic resonance imaging -- sensitivity -- specificity; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599818756300
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objective: To reevaluate asymmetric sensorineural hearing loss (ASNHL) criteria used to justify magnetic resonance imaging (MRI) in the evaluation of retrocochlear tumors in a military population. Study Design: Retrospective case‐control study. Setting: Tertiary care military medical center. Subjects and Methods: Patients with military service and a history of ASNHL prompting referral for MRI, with or without retrocochlear tumors, were compared between 2005 and 2016. Predictor variables included pure tone ASNHL, speech audiometry, and a history of noise exposure. Logistic regression models for hearing asymmetries were performed, and receiver operator curves were used to calculate sensitivity and specificity. Results: Thirty‐eight retrocochlear tumors were identified. The MRI diagnosis rate for patients with ASHNL was 0.85%. Patients with tumors were slightly older (42 vs 37 years, P =. 021) and had less noise exposure (47% vs 85%, P <. 001). A sensitivity of 0.83 and a specificity of 0.58 were calculated for asymmetries ≥10 dB at 2000 Hz without adjusting for noise exposure. Instituting this imaging threshold would have reduced the number of MRI scans by half while missing 16% of tumors. Conclusion: The tumor diagnosis rate among those undergoing MRI for ASNHL is low in the military population, likely because service‐related noise exposure commonly causes ASNHL. Optimal MRI referral criteria should conserve resources while balancing the risks of over‐ and underdiagnosis. For those with a history of military service, an asymmetry ≥10 dB at 2000 Hz among patients meeting current ANSHL referral criteria is most predictive of a retrocochlear tumor.