title: The Agreement between Protocols for the Investigation of Asymmetrical Audiovestibular Symptoms.
abstract: OBJECTIVE
  There are a number of published criteria for the investigation of asymmetrical audiovestibular symptoms. Our aim was to determine the agreement between these protocols when determining whether to investigate a group of patients treated at our institution.
  
  
  METHODS
  Retrospective audit of the indications for arranging 854 consecutive magnetic resonance imaging scans of the internal auditory meatus. These indications were compared to the Oxford, Northern, Charing Cross, and Nashville guidelines on the investigation of asymmetrical audiovestibular symptoms.
  
  
  RESULTS
  The level of agreement was low, with kappa values ranging between 0.15 and 0.58 between the four selected protocols.
  
  
  CONCLUSIONS
  While these criteria seem very similar in nature, due to the number of patients with mild asymmetry and subtle distinctions such as the inclusion or exclusion of tinnitus, there are low levels of agreement between protocols. This study highlights another area of difficulty when determining which patients to investigate.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital, London, United Kingdom. mr.robert.nash@gmail.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Nash
authors.forename: Anooj
authors.initials: A
authors.lastname: Majithia
authors.forename: Arvind
authors.initials: A
authors.lastname: Singh
mesh_terms: D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004739:England; D007839:Functional Laterality / Q000502:physiology; D019983:Guideline Adherence; D046088:Hearing Loss, Unilateral / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008485:Medical Audit; D008575:Meniere Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D009464:Neuroma, Acoustic / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D013222:State Medicine; D014012:Tinnitus / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D019564:Unnecessary Procedures; D014724:Vestibular Function Tests / Q000379:methods*