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Otology/Neurotology

(392) Practice Patterns in Asymmetric Sensorineural Hearing Loss: Survey Data

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Kareem Al-Mulki, MD

    Resident
    Department of Otolarynology - Head and Neck Surgery, Montefiore Medical Center
    Bronx, New York, United States

  • ES

    Elliot Schiff, N/A

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

    • Co-Author(s)

  • Sara Friedman

    MD Candidate
    Albert Einstein College of Medicine
    Bronx, New York, United States

    • Senior Author(s)

  • HM

    Howard Moskowitz, MD, PhD

    Associate Professor
    Department of Otolarynology - Head and Neck Surgery, Montefiore Medical Center
    Bronx, New York, United States

Disclosure(s):
Kareem Al-Mulki, MD: No relevant relationships to disclose.
Elliot Schiff, BA: No relevant relationships to disclose.
Sara Friedman: No relevant relationships to disclose.
Howard Moskowitz, MD, PhD: No relevant relationships to disclose.


Introduction: Asymmetric sensorineural hearing loss is the most common presenting complaint of vestibular schwannomas and gadolinium-enhanced MRI is the gold standard for detecting such lesions. However, MRI is expensive, difficult to tolerate for many patients, time-consuming, and has a low diagnostic yield of only 1-5%. Though various screening protocols for obtaining MRI have been proposed, the threshold of hearing loss which guides actual clinical decision-making remains understudied. This project aims to improve management of asymmetric sensorineural hearing loss by comparing real-world protocols followed by practitioners to guide imaging practices.

Methods: A list of 276 names and emails was compiled by searching for otology/neurotology specialists at North American residency programs. A survey was created consisting of three parts: demographics, general practice patterns, and simulated patient cases. Surveys were distributed with a single reminder 7 days later. Survey responses were analyzed for trends and distribution of consensus on our topics of interest.

Results: 258 surveys were successfully distributed, resulting in 65 (25.2%) responses. Respondents were distributed across the United States, with 25 (38.5%) in the Northeast, 16 (24.6%) Midwest,15 (23.1%) Southeast, 6 (9.2%) Southwest. The majority of respondents (49.2%) self-reported their definition of ASNHL as “>30dB hearing asymmetry at one frequency OR >20 dB hearing asymmetry at two continuous frequencies OR >10dB hearing asymmetry at three contiguous frequencies”. Interestingly, 41.5% of respondents stated that “any asymmetry alone is an indication for further testing.” Respondents cited many factors in guiding their decision-making, including: cost (40%), time (21.5%), low probability of positive finding (70.8%), patient preference (15.4%), patient history (13.8%), and patient age (13.8%).

Conclusions:

Conclusion:
Otology/Neurotology specialists are not unanimous in their approach to patients with ASNHL and evidence based guidelines would be useful in guiding imaging of patients.