Cost Comparison of Auditory Brainstem Response versus Magnetic Resonance Imaging Screening of Acoustic Neuroma

AbstractObjective:The aim of this study was to investigate the contribution of electronystagmography and magnetic resonance imaging to the aetiological diagnosis of vertigo and unsteadiness, in a population in which the history and clinical examination provide no conclusive diagnosis of the origin of the dysfunction (i.e. peripheral or central).Patients and methods:This retrospective study included 102 patients, who underwent full ENT clinical evaluation, history and neurotological assessment (including pure tone audiography, auditory brainstem response testing, electronystagmography and magnetic resonance imaging).Results:Electronystagmography contributed to establishment of a diagnosis in 53/102 patients (52 per cent), whereas magnetic resonance imaging did the same in four of 102 patients (3.9 per cent).Conclusion:Electronystagmography remains the most useful examination for aetiological diagnosis of patients with vertigo and unsteadiness, since the actual number of patients with vertigo and unsteadiness of central origin is small (3.9 per cent), even in a population in which history and clinical examination may indicate an increased probability of central nervous system dysfunction.

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Vestibular signs and symptoms of volumetric abnormalities of the vestibular aqueduct

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000400 ◽

2007 ◽

Vol 122 (6) ◽

pp. 557-563 ◽

Cited By ~ 3

Author(s):

L Manzari

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Motion Sickness ◽

Auditory Brainstem ◽

Vestibular Evoked Myogenic Potentials ◽

Resonance Imaging ◽

Vestibular Evoked Myogenic Potential ◽

Vestibular Aqueduct ◽

Brainstem Response

AbstractObjective:The objective of this study was to identify a pattern of signs, symptoms and neuroradiological findings which would assist investigation of vestibular function (especially otolith function) in a group of adult patients with anatomical alterations of the endolymphatic aqueduct and sac.Methods:Fifteen subjects affected by volumetric abnormalities of the vestibular aqueduct were selected from a cohort of patients referred to a tertiary referral neurotological centre between 1 January 2004 and 30 June 2006. All patients underwent accurate clinical history-taking and were evaluated using a standardised set of bedside and instrumental neurotological tests (i.e. audiometry, auditory brainstem response and vestibular evoked myogenic potentials). After these tests, each patient underwent computed tomography and magnetic resonance imaging in order to accurately evaluate the middle ear, labyrinthine capsule and internal auditory canals. These evaluations confirmed clinical suspicion of volumetric abnormalities of the vestibular aqueduct and endolymphatic sac.Results:All the patients with a defined volumetric alteration in the region of the vestibular aqueduct and endolympatic sac reported a typical pattern of symptoms and signs. The most obvious and frequent symptoms in these patients were migraine-related vertigo (using the Neuhauser criteria, 10 of 15, 66.6 per cent), ‘motion sickness’ (12 of 15, 80 per cent), oscillopsia (nine of 15, 60 per cent) and dizziness (14 of 15, 93.3 per cent). Clinical examination results for the selected patients allowed some useful speculative conclusions. During neurotological evaluation, two instrumental methodologies were especially useful diagnostically: vestibular evoked myogenic potentials of the neck, and the mastoid vibration test at 100 Hz.Conclusions:Dysfunction of the vestibular aqueduct is suggested by symptomatology characterised by: migraine-related vertigo, unstable or recurring oscillopsia, lowering of the vestibular evoked myogenic potential threshold, hypoacusis, anamnestic report of motion sickness, and nystagmus induced by mastoid vibration and head-shaking. Computed tomography and magnetic resonance imaging are needed in order to confirm clinical suspicions.

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Magnetic resonance imaging screening in acoustic neuroma

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2009.02.005 ◽

2010 ◽

Vol 31 (4) ◽

pp. 217-220 ◽

Cited By ~ 15

Author(s):

Jonathan R. Newton ◽

Muhammad Shakeel ◽

Sam Flatman ◽

Craig Beattie ◽

Bhasker Ram

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Acoustic Neuroma ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Screening

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Brain magnetic resonance imaging findings and auditory brainstem response in a child with spastic paraplegia 2 due to a PLP1 splice site mutation

Brain and Development ◽

10.1016/j.braindev.2014.03.001 ◽

2015 ◽

Vol 37 (1) ◽

pp. 158-162 ◽

Cited By ~ 3

Author(s):

Kazuo Kubota ◽

Yoshiaki Saito ◽

Chihiro Ohba ◽

Hirotomo Saitsu ◽

Tetsuhiro Fukuyama ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Auditory Brainstem Response ◽

Brain Magnetic Resonance Imaging ◽

Splice Site Mutation ◽

Auditory Brainstem ◽

Imaging Findings ◽

Spastic Paraplegia ◽

Resonance Imaging ◽

Site Mutation ◽

Brainstem Response

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Ultra high resolution nonenhanced fast spin echo magnetic resonance imaging: Cost-effective screening for acoustic neuroma in patients with sudden sensorineural hearing loss

Otolaryngology ◽

10.1016/s0194-5998(98)70080-4 ◽

1998 ◽

Vol 119 (4) ◽

pp. 364-369 ◽

Cited By ~ 43

Author(s):

Robert L. Daniels ◽

Clough Shelton ◽

H. Ric Harnsberger

Keyword(s):

Magnetic Resonance Imaging ◽

Hearing Loss ◽

Magnetic Resonance ◽

Sensorineural Hearing Loss ◽

Acoustic Neuroma ◽

Spin Echo ◽

Sudden Sensorineural Hearing Loss ◽

Fast Spin Echo ◽

Resonance Imaging ◽

Fast Spin

The financial burden for the evaluation of patients for acoustic neuroma in an otolaryngology practice is substantial. Patients with sudden sensorineural hearing loss represent a portion of that population seen with unilateral, asymmetric auditory symptoms who require investigation for acoustic neuroma. For these patients, gadolinium-enhanced magnetic resonance imaging is the diagnostic gold standard. Auditory brain stem response testing has been used in the past as a screening test for acoustic neuroma, but its apparent sensitivity has fallen as the ability to image smaller acoustic neuromas has improved. Fast spin echo magnetic resonance imaging techniques without gadolinium have been shown to be as effective in the detection of acoustic neuroma as contrast-enhanced magnetic resonance imaging. Limited nonenhanced fast spin echo magnetic resonance imaging now provides an inexpensive alternative for high-resolution imaging of the internal auditory canal and cerebellopontine angle. Fast spin echo magnetic resonance imaging can now be done at a cost approximating auditory brain stem response testing while providing the anatomic information of contrast-enhanced magnetic resonance imaging. Cost analysis was done in the cases of 58 patients with sudden sensorineural hearing loss by comparing the costs for routine workup and screening of acoustic neuroma with the cost of fast spin echo magnetic resonance imaging with the use of screening protocols based on literature review. The potential cost savings of evaluating patients with sudden sensorineural hearing loss with fast spin echo magnetic resonance imaging for acoustic neuroma was substantial, with a 54% reduction in screening costs. In an era of medical economic scrutiny, fast spin echo magnetic resonance imaging has become the most cost-effective method to screen suspected cases of acoustic tumors at our institution by improving existing technology while reducing the cost of providing that technology and eliminating charges for impedance audiometry, auditory brain stem response testing, and contrast-enhanced magnetic resonance imaging.

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