Asymmetric sensorineural hearing loss in a community-based population

Asymmetric sensorineural hearing loss (ASNHL) is fairly common, but it can be an indication of retrocochlear pathology, The incidence of acoustic neur oma (AN) has been estimated at 1/100,000; however, the incidence of AN in p atients with ASNHL is unknown. The limitation of health care resources chal lenges otolaryngologists to develop reasonable cost-containment guidelines for the evaluation of patients with ASNHL for the presence of retrocochlear pathology. A 5-year (1990 to 1994) retrospective study of all patients wit h ASNHL who were evaluated in a community-based general otolaryngology prac tice was performed. Demographic, historic, and audiologic data and results from ABRs and radiologic studies were summarized. ASNHL was present in 325 patients. Auditory brain stem response tests were performed in 179 patients (55%), and 92% (164 of 179) were normal. Patients with abnormal or inconcl usive auditory brain stem responses and patients with severe SNHL were eval uated with radiologic studies (46 patients), Among the 193 patients who had diagnostic studies, 4 were found to have ANs, for a prevalence of 2.1%, Th e charge of diagnosis per AN was more than $41,000, In summary, a small per centage of patients with ASNHL have retrocochlear pathology, and the charge of diagnosis per AN can be excessive. A cost-containment approach for the evaluation and management of patients with ASNHL is proposed.