Expert opinion on the diagnosis of acoustic tumors.
Ideally, clinicians recommend diagnostic tests when the patient's risk of disease is sufficient to justify putting numerous similar patients through the morbidity required to diagnose disease in one patient. In the case of acoustic tumor diagnosis, there are few published data available to the clinician to help assess risk in an individual patient. The purpose of this study was to obtain information by an opinion poll of a group of experts. We used the Delphi method to poll clinicians trained at the House Ear Clinic. We asked these experts 20 questions related to acoustic tumor diagnosis. Some of the expert opinion presented herein is the only data related to acoustic tumor diagnosis available to clinicians. These data are a first step in elevation of decision-making for tumor diagnosis above the level of speculation. However, the experts' responses displayed a pattern of inaccuracy that limits the clinical application of their opinion. Exposing this pattern was instructive for identifying desirable features of protocols for diagnosing tumors. We recommend that protocols not depend on clinicians estimating probability of tumor. Instead, protocols may list specific findings, such as unilateral distortion on the telephone, to indicate, when present, that the risk of tumor is sufficient to order a diagnostic test.
Mangham
C A
CA
Seattle Ear Clinic, Washington 98122-3571, USA.
D000328:Adult; D000368:Aged; D003390:Cranial Nerve Neoplasms / Q000150:complications / Q000175:diagnosis*; D003697:Delphi Technique; D016057:Evoked Potentials, Auditory, Brain Stem; D006319:Hearing Loss, Sensorineural / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000175:diagnosis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D000160:Vestibulocochlear Nerve Diseases / Q000150:complications / Q000175:diagnosis*