Asymmetric sudden sensorineural hearing loss: is all this testing necessary?

Area of Science:

• Otolaryngology
• Audiology
• Diagnostic Medicine

Background:

• Asymmetric sudden sensorineural hearing loss (ASSNHL) diagnosis typically involves extensive serologic testing and imaging.
• The etiological factors contributing to ASSNHL are diverse, necessitating a thorough diagnostic workup.
• The clinical utility and cost-effectiveness of the standard ASSNHL diagnostic battery remain areas for investigation.

Purpose of the Study:

• To evaluate the diagnostic yield of a comprehensive battery of tests for ASSNHL.
• To determine the average cost associated with the standard diagnostic workup for ASSNHL.
• To inform clinical practice regarding the most effective diagnostic strategies for ASSNHL.

Main Methods:

• Retrospective chart review of patients diagnosed with ASSNHL at a tertiary care facility.
• Analysis of diagnostic tests performed, including serologic markers and magnetic resonance imaging.
• Cost analysis of the complete diagnostic evaluation was conducted.

Main Results:

• The comprehensive diagnostic evaluation for ASSNHL, costing over $2000, yielded a very low rate of positive results.
• Commonly ordered tests included antineutrophil antibody, Lyme titer, rheumatoid factor, and MRI with gadolinium.
• The overall diagnostic impact of the extensive testing was found to be minimal.

Conclusions:

• The routine, comprehensive evaluation for ASSNHL lacks significant diagnostic utility.
• Diagnostic strategies for ASSNHL should be individualized, prioritizing patient-specific risk factors and exposures.
• Reconsideration of the current diagnostic paradigm for ASSNHL is warranted to improve efficiency and cost-effectiveness.