title: Three-year ear, nose, and throat cross-sectional analysis of audiometric protocols for magnetic resonance imaging screening of acoustic tumors.
abstract: OBJECTIVE
  (1) Evaluate audiometric protocols and recommend protocols with best sensitivity and specificity for magnetic resonance imaging (MRI) screening of acoustic tumors; (2) determine clinical risks (false negative) of missing acoustic tumors and potential wastes in screening (false positive) nonacoustic tumors or radiologically "normal" cases; and (3) identify the decibel difference and range of frequencies compared by the best-performing protocols.
  
  
  METHODS
  Cross-sectional study with chart review.
  
  
  METHODS
  Ear, nose, and throat (ENT); audiology; and radiology departments in a tertiary-care hospital.
  
  
  METHODS
  Three-year cohort (2006-2009) of 1751 ENT patients underwent MRI screening and pure-tone audiometry indicating sensorineural hearing loss. Audiometric protocols were ranked by highest sensitivity to acoustic tumors, specificity A to nonacoustic tumors, and specificity B to "radiologically normal" cases.
  
  
  RESULTS
  No audiometric protocols achieved 100% sensitivity or specificity rates. Only 2 protocols achieved ≥90% sensitivity: the AMCLASS-A-Urben protocol (93.16%) and the Mangham protocol (91.58%). Eleven of 15 protocols for specificity A and 12 of 15 protocols for specificity B achieved ≥50%. Clinical risks ranged from 6.84% to 18.95%, whereas potential wastes ranged from 33.56% to 68.37% for specificity A and 31.76% to 66.86% for specificity B. Interaural difference parameters indicating highest mean sensitivity were on the order of ≥10 dB, ≥15 dB, and ≥20 dB. For frequency comparison parameters, "2 or more adjacent frequency" and "single-frequency" comparison indicated higher mean sensitivity than the "averaged multifrequency" comparison. Mean specificity showed an opposite pattern.
  
  
  CONCLUSIONS
  For optimum sensitivity, the Mangham protocol is preferred (sensitivity, 91.58%; specificity A, 44.23%; specificity B, 44.91%), which proposes a ≥10-dB interaural difference, averaging 1 to 8 kHz. For optimum specificity, the American Academy of Otolaryngology-Head and Neck Surgery protocol is preferred (sensitivity, 87.37%; specificity A, 65.38%; specificity B, 66.04%), which proposes ≥15 dB between ears, averaging 0.5 to 3 kHz.
authors.affiliation: Barts and the London NHS Trust, London, England. TCheng@nhs.net
authors.forename: Teddy Caramoan
authors.initials: TC
authors.lastname: Cheng
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wareing
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone / Q000379:methods*; D003430:Cross-Sectional Studies; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006782:Hospitals, Special; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D010036:Otolaryngology / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D013997:Time Factors; D006113:United Kingdom