Author(s)
Laiken Griffith, BA
Michael W. Canfarotta, MD
Ina A. Lee, MS
Annie Shen, BS
Nadine I. Ibrahim, MD
David S. Haynes, MD
Kareem O. Tawfik, MD
Affiliation(s)
Vanderbilt University Medical Center
Abstract:
Objective: 1) To estimate the prevalence of asymmetric sensorineural hearing loss (AHL) in adult cochlear implant (CI) candidates, and 2) to characterize the sensitivity and specificity of AHL in identifying retrocochlear pathology in this population.
Study Design: Retrospective cohort.
Setting: Tertiary referral center.
Patients: Two thousand thirty-eight adult patients who underwent a CI evaluation between 2002 and 2024.
Interventions: Cochlear implant candidacy evaluation and magnetic resonance imaging (MRI) of the temporal bone.
Main Outcome Measures: Three different criteria were used to define AHL: 1) interaural asymmetry =10 dB at 3 consecutive frequencies (10 dB AHL), 2) interaural asymmetry =15 dB at 2 consecutive frequencies (15 dB AHL), and 3) interaural asymmetry =20 dB or =30 dB at 2 consecutive frequencies if <65 or =65 years old, respectively (American Neurotology/Otological Society [ANS/AOS] AHL guidelines). Presence or absence of retrocochlear pathology was determined on MRI.
Results: The prevalence of AHL was 67.0%, 60.4%, and 34.5% when using 10 dB AHL, 15 dB AHL, and ANS/AOS AHL guidelines, respectively. Retrocochlear pathology was identified in 3.5% of patients that underwent MRI. The ANS/AOS AHL guidelines offered higher specificity in identifying retrocochlear pathology when compared to the 15 dB AHL and 10 dB AHL guidelines (64.8%, 38.9%, 32.3%, respectively) yet came at the tradeoff of reduced sensitivity (54.4%, 78.9%, 82.5%, respectively).
Conclusions: The prevalence of AHL in CI candidates varies widely based on definition, ranging from 34.5% to 67.0% in the present cohort. The new ANS/AOS guidelines for AHL demonstrated the highest specificity yet lowest sensitivity in the identification of retrocochlear pathology in this population. These findings may aid clinicians in the preoperative selection of imaging modality for CI candidates.
Learning Objective: Many patients referred for evaluation of cochlear implant candidacy present with a “better-hearing ear.” The objectives of this presentation are 1) to understand the prevalence of asymmetric sensorineural hearing loss in cochlear implant candidates and 2) to describe the sensitivity and specificity of various definitions of asymmetric hearing loss in identifying retrocochlear pathology in this population.
Desired Result: At the conclusion of this presentation, providers should be able better counsel patients on the utility of preoperative magnetic resonance imaging in detecting retrocochlear pathology in cochlear implant candidates with asymmetric sensorineural hearing loss.
Level of Evidence – Level IV
Indicate IRB or IACUC: IRB #240876, Vanderbilt University