S210 – Asymmetric Sudden SNHL: Is All This Screening Necessary?

Abstract

Objectives A number of factors have been identified that contribute to the presentation of asymmetric sudden sensorineural hearing loss (ASSNHL). Routinely patients presenting with ASSNHL undergo a battery of serologic testing and imaging in an attempt to determine a cause. The study will assess the utility of this diagnostic evaluation in elucidating a cause of an asymmetric sensorineural hearing loss. At the conclusion of this presentation, the participants should be able to: 1) Understand the utility of diagnostic screening in the management of ASSNHL. 2) Understand the cost-effectiveness of the diagnostic screening for ASSNHL. Methods The study design is a retrospective chart review. Charts from patients presenting to the otolaryngology clinic of a tertiary care facility between January 1, 2000, and November 30, 2007, with ASSNHL confirmed with audiometric evaluation were reviewed. Diagnostic tests included in the work-up of ASSNHL and test results were recorded. Percentage of positive tests was determined and compared to national data. Cost analysis of the diagnostic battery was performed. Results All patients presenting with sudden sensorineural hearing loss received 1 or more of the following serologic and radiographic tests: ANA, cholesterol, creatinine, DNA-ds, ESR, blood glucose, Lyme titer, rheumatoid factor, RPR, FTA-ABS, HSP, T3, TSH and MRI with gadolinium. The average cost associated with the full diagnostic evaluation is greater than $1,500. The positive rate for any of these tests was extremely low. Conclusions The utility of the comprehensive ASSNHL evaluation should be reconsidered. The choice of diagnostic evaluation should be directed by patient risk factors and exposures.