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  • Title: Medicolegal concerns among neurotologists in ordering MRIs for idiopathic sensorineural hearing loss and asymmetric sensorineural hearing loss.
    Author: Jiang ZY, Mhoon E, Saadia-Redleaf M.
    Journal: Otol Neurotol; 2011 Apr; 32(3):403-5. PubMed ID: 21358454.
    Abstract:
    OBJECTIVE: To determine if neurotologists order magnetic resonance imaging (MRI) in cases of idiopathic sudden sensorineural hearing loss (sudden deafness) and of asymmetric sensorineural hearing loss (ASNHL) for medicolegal reasons. STUDY DESIGN: Survey of 480 American neurotologists. MAIN OUTCOME MEASURES: 1) The frequency with which neurotologists/otologists in the United States order MRI in sudden deafness and ASNHL, 2) the frequency of medicolegal issues as motivations for ordering MRIs, 3) the frequency of abnormal MRIs, and 4) the prevalence of auditory brainstem reflex (ABR) and acoustic reflex testing as screening tools before ordering an MRI. RESULTS: Approximately 146 responses (30.4%) were received. Ninety-five percent and 94% ordered MRIs in their patients with ASNHL and sudden deafness respectively. Forty percent of the respondents said medicolegal concerns factored into their decision to order a scan. Seventy-seven percent and 82% reported finding vestibular schwannomas in less than 1% to 4% of MRIs for ASNHL and sudden deafness, respectively. Approximately one-third of the respondents still use ABR and acoustic reflex testing as screening tools. CONCLUSION: MRIs are the gold standard for determining retrocochlear pathology in the setting of sudden deafness and ASNHL but are expensive. Approximately one-third of the respondents still use ABR and acoustic reflex testing as screening tools before ordering MRI. MRI typically have a low yield in finding an abnormality (usually <1%-4%). Neurotologists in our survey seem to recognize this quandary: they usually order an MRI, although they know it will usually be negative, and 40% of them cite medicolegal concerns as one of the motivations for their decision. This suggests that routine use of MRI partially reflects the practice of defensive medicine rather than medicine based on evidence. Perhaps MRIs are rarely indicated as the initial screening tool in ASNHL and sudden deafness, given their high cost and low yield of abnormal findings, and their routine use should and could be reduced to contain medical costs.
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