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What defines asymmetric sensorineural hearing loss?
Author(s) -
Durakovic Nedim,
Valente Michael,
Goebel Joel A.,
Wick Cameron C.
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27504
Subject(s) - schwannoma , medicine , vestibular system , sensorineural hearing loss , cerebellopontine angle , hearing loss , audiology , acoustic neuroma , magnetic resonance imaging , radiology
BACKGROUND Defining significant asymmetric sensorineural hearing loss (ASNHL) is important to determine if a patient requires further evaluation for retrocochlear pathology. Currently, gadolinium-enhanced magnetic resonance imaging (MRI) is the gold standard to identify pathology in the internal auditory canal (IAC) and cerebellopontine angle (CPA) responsible for ASNHL. The most common lesion in the IAC and CPA is a vestibular schwannoma with the sensitivity and specificity of MRI approaching 100% for these tumors. ASNHL is the most common presenting symptom associated with a vestibular schwannoma, but the degree of asymmetry varies greatly, and some patients may even have symmetric hearing. Thus, defining what degree of ASNHL places a patient at higher risk for vestibular schwannoma detection continues to be debated in the literature without consensus. A broad definition of ASNHL will increase sensitivity and identify a greater number of tumors, but it will also generate a greater number of negative studies, increased healthcare costs, and greater patient anxiety. A narrow definition of ASNHL increases specificity but risks missing a diagnosis and a potential therapeutic window for hearing-preservation surgery, stereotactic radiation, or improved facial nerve outcomes. Thus, the definition of clinically significant ASNHL requires optimization of both sensitivity and specificity to maximize its benefit as a screening tool for retrocochlear pathology.