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Clinical Challenges
July 19, 2010

Clinical Thresholds for When to Test for Retrocochlear Lesions: Pro

Author Affiliations

Author Affiliation:Department of Head and Neck Surgery, Southern California Permanente Medical Group, San Diego.



Arch Otolaryngol Head Neck Surg. 2010;136(7):725-727. doi:10.1001/archoto.2010.101

Hypothesis:To establish the hypothesis that the clinical and audiometric thresholds prompting testing for retrocochlear disease should be liberal.

The question, “What are appropriate clinical thresholds that would trigger further testing for retrocochlear lesions?” has a very long history. Harvey Cushing, MD, first identified unilateral hearing loss and tinnitus as cardinal symptoms of acoustic neuromas in his classic 1917 monograph.1Since then, the evaluation of asymmetric sensorineural hearing loss (ASNHL) (and other associated symptoms) has been the central focus regarding the search for retrocochlear disease. Long before the advent of magnetic resonance imaging (MRI), various audiometric tests were developed for their usefulness in selecting which patients with ASNHL should be subjected to more invasive testing in the search for retrocochlear causes of hearing loss (HL) such as an acoustic neuroma or other cerebellopontine angle (CPA) lesions.2,3In that era (prior to the late 1970s), the radiological testing was quite invasive and carried potential for significant complications.4,5Finding small tumors with these techniques was challenging.

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