In an era of ever-increasing scrutiny on containment of health care costs, it is important to appropriately identify individuals who should undergo more extensive and expensive evaluation to rule out a retrocochlear lesion. To that end, we seek less costly outcome measures that separate those who should have an MRI from those who can be safely watched. It is unfortunate that medical disorders do not always allow a single measure to validate a clinical decision. Such is the case with screening for retrocochlear disease, such as a VS. The incidence of VS is usually quoted as 1 in 100 000 individuals in the general population; however, Schwartz and Fisher1recently reported the incidence as high as 1 in 20 000 in a city in the United States (Beverly Hills, California) that has a high usage of MRI scanning for other medical conditions. Five of 11 patients identified as having tumors on MRI were asymptomatic for HL, tinnitus, or balance problems and displayed audiograms with symmetric normal hearing. In light of this, is the audiogram the appropriate screening tool to guide further evaluation?
Bruce J. Gantz, MD
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