KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMD
All patients with newly documented asymmetrical sensorineural hearing loss should undergo auditory brainstem response (ABR) audiometry. If the results are normal, magnetic resonance imaging (MRI) is not required to rule out acoustic neuroma.
Acoustic neuroma, which is more commonly but less accurately called acoustic neuroma, is the most frequently occurring neoplasm of the cerebellopontine angle. Each year in the United States, 2000 to 3000 new cases are diagnosed.1 The most common symptom of acoustic neuroma, progressive asymmetrical sensorineural hearing loss, is found in 80% to 95% of patients, depending on the size of the tumor.2 Definitive diagnosis of acoustic neuroma is possible with nearly perfect sensitivity and specificity using gadolinium-enhanced MRI of the internal auditory canals. However, even in a neurotology referral center, only 5% of patients with asymmetrical sensorineural hearing loss or unilateral tinnitus actually have a finding on MRI that could account for their hearing loss and only 1% are diagnosed as having acoustic neuroma.3 Thus, 99% of patients with the typical presenting symptoms of acoustic neuroma will not have a tumor on their scan. Therefore, the cost-effectiveness of routinely performing MRI has been called into question.
Doyle KJ. Is There Still a Role for Auditory Brainstem Response Audiometry in the Diagnosis of Acoustic Neuroma?. Arch Otolaryngol Head Neck Surg. 1999;125(2):232-234. doi:10.1001/archotol.125.2.232