(260) Incidentalomas in the Work-up of Asymmetric Hearing Loss

Introduction: The gold-standard assessment of asymmetric sensorineural hearing loss (ASNHL) for retrocochlear pathology is contrast-enhanced MRI. Although the reported rates of identifying a vestibular schwannoma are low (1-4%), it is generally believed that this is a cost-effective practice. Yet, few if any studies have included the non-insubstantial costs associated with incidentalomas (unanticipated findings). This study aims to characterize the incidence and nature of incidentalomas in the workup as ASNHL and to quantify the economic burden.

Methods: Radiology records were queried for all MRI’s ordered for ASNHL between January 2012 to November 2022. Results were characterized as “Normal”, “Abnormal Read/Normal Variant” requiring no further workup, “Abnormal- Likely Cause of ASNHL”, or “Abnormal- Follow up Needed”.

Results: Six hundred patients met inclusion criteria. 64.5% (n=387) were categorized as “Normal” and 24.7% (n=151) were “abnormal read/normal variants”. A total of 3.3% (n=20) of patients had abnormal findings related to ASNHL and 7% (n=42) had abnormal findings that warranted further workup. Much of these workups required referral visits to other specialties including neurosurgery and endocrinology, imaging such as additional MRIs and CT scans, and labs including hormone panels. Of these 42 patients, 7.1% (n=3) had interventions to treat their incidental findings.

Conclusions: Incidentalomas occur at over twice the rate of the retrocochlear pathology responsible for ASNHL. Although the number of patients requiring treatment for incidentaloma is low, the economic impact is substantial. Such findings should be considered when considering the cost burdens to the individual and the health system payers.