Cost-benefit ratio in our search for cerebellopontine angle tumors

There is agreement that the morbidity and mortality of CPA tumors are directly proportional to the size of the tumor. The diagnostic difficulty, however, is indirectly proportional to the size: the large tumors are diagnosed with little difficulty, the smaller ones with considerable challenge. In the search for these tumors, it is apparent that the incidence of all sizes is low. To arrive at the diagnosis, efforts must be pursued in any patient with unilateral sensorineural hearing loss, unilateral tinnitus, or vertigo. In the past 12 years, 19,000 new patients were seen in the office of the Pittsburgh Otological Association. In this new patient population, 120 tumors were proven by surgery. Six others (bilateral tumors) were diagnosed but not operated on, and four others were diagnosed but were operated on elsewhere for a total of 130 patients. An estimate of the cost of diagnosing these tumors is presented. Consideration is given to the cost-benefit ratio of diagnosing those diseases which must be considered also in the differential diagnosis when the above symptoms are present. These are: congenital changes, trauma, metabolic neuropathies, Meniere's disease, noise-induced hearing loss, lues, sudden hearing loss, and unilateral symptoms of undetermined etiology.