Analysis of the efficiency of retrocochlear screening

The auditory brainstem response (ABR), as well as associated audiologic and radiographic studies of 175 patients suspected of having cerebellopontine angle tumors were reviewed. The majority of patients presented with asymmetric hearing loss. Eight acoustic neuromas were identified. All eight had abnormal ABRs. The false-positive rate was 22%. Rollover and acoustic reflex testing played a minimal role in the decision as to whether or not an ABR was ordered and, as a result, are not important in the search for retrocochlear disease. The cost per tumor diagnosed was roughly $7600. A rational approach to tumor screening based on the efficiency and cost of the screening tests, the frequency of abnormal ABRs, and the cost per tumor diagnosed is presented.