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Otol Neurotol. 2015 Feb;36(2):277-81. doi: 10.1097/MAO.0000000000000649.

Cost-effective analysis of unilateral vestibular weakness investigation.

Author information

1
*Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, New York; and †New York Medical College, Valhalla, New York, U.S.A.

Abstract

OBJECTIVES:

To evaluate the cost-effectiveness of obtaining a magnetic resonance imaging (MRI) in patients with abnormal electronystagmography (ENG) or videonystagmography (VNG) results.

STUDY DESIGN:

Retrospective chart review.

SETTINGS:

Academic specialty center.

PATIENTS:

Patients presenting with vertigo between January 1, 2010, and August 30, 2013.

METHODS:

Patients who fit the following abnormal criteria were included in the study: unilateral caloric weakness (≥20%), abnormal ocular motor testing, and nystagmus on positional testing. Patients with abnormal findings who then underwent MRI with gadolinium were evaluated.

RESULTS:

Of the 1,996 charts reviewed, there were 1,358 patients who met the inclusion criteria. The average age of these patients was 62 years (12-94 yr). The male:female ratio was approximately 1:2. Of the 1,358 patients, 253 received an MRI with the following pathologies: four vestibular schwannomas, three subcortical/periventricular white matter changes suspicious for demyelinating disease, four acute cerebellar/posterior circulation infarct, two vertebral artery narrowing, one pseudomeningocele of internal auditory canal, and two white matter changes indicative of migraines. The positive detection rate on MRI was 5.5% based on MRI findings of treatable pathologies causing vertigo. Average cost of an MRI is $1,200, thereby making the average cost of identifying a patient with a positive MRI finding $15,180.

CONCLUSION:

In our study, those patients with a positive MRI had a constellation of symptoms and findings (asymmetric sensorineural hearing loss, tinnitus, vertigo, and abnormal ENG/VNG). Cost-effectiveness can be improved by ordering an MRI only when clinical examination and VNG point toward a central pathology. Clinical examination and appropriate testing should be factored when considering the cost-effectiveness of obtaining an MRI in patients with abnormal ENG/VNG findings.

PMID:
25420081
DOI:
10.1097/MAO.0000000000000649
[Indexed for MEDLINE]

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