Cost-effective initial screening for vestibular schwannoma: auditory brainstem response or magnetic resonance imaging?

OBJECTIVE Our goal was to determine the cost-effectiveness of including auditory brainstem response (ABR) testing in a screening protocol for the diagnosis of vestibular schwannoma (VS) in patients with asymmetric auditory symptoms at the Christian Medical College and Hospital, Vellore, India, where, commonly, patients with VS have tumors greater than 2 cm at the time of diagnosis. METHODS Ninety patients with asymmetric audiovestibular symptoms were investigated prospectively with both ABR and gadolinum-enhanced magnetic resonance imaging (GdMRI). RESULTS Of these 90 patients, 6 were diagnosed with VS on GdMRI. On ABR testing, 4 patients with VS had retrocochlear pathology and 2 with profound sensorineural hearing loss had no responses. ABR was found to have a sensitivity of 100% and specificity of 61.9%. A protocol involving screening of all patients with asymmetric audiovestibular symptoms using ABR and only subjecting those patients with no responses or retrocochlear pathology to GdMRI would effect a savings of $1200 for every patient detected to have a VS. CONCLUSIONS In our hospital setting, including ABR as the preliminary screen for patients with asymmetric audiovestibular symptoms is a cost-effective strategy.