—Reviewed by Amy Eckner
Explore This IssueSeptember 2013
CT, MRI Not Useful for Evaluation of ED Patients with Dizziness
Are computed tomography (CT) and magnetic resonance imaging (MRI) useful and cost-effective in the evaluation of patients with dizziness in the emergency department (ED)?
Background: Dizziness is the chief complaint in about 4 percent of patients presenting to the ED. Because the differential diagnosis for dizziness is extensive, many physicians, including otolaryngologists, use imaging as a first-line modality to rule out more serious causes.
Study design: Retrospective chart review of patients with a specific health maintenance insurance plan presenting with dizziness and vertigo between January 2008 and January 2011.
Setting: Henry Ford Health System, Detroit.
Synopsis: A total of 1,681 charts were reviewed to examine the presenting complaints, physical exam, laboratory test and radiological tests. Patients with a history of stroke, brain tumor, recent neurosurgery or a predisposing neurological disorder were excluded. Of 1,028 patients who received CT, 810 were specifically for dizziness or vertigo; of those, only 50 had abnormal findings, with six that were clinically significant. Of the 90 patients who received MRI, 16 had abnormal findings, with 11 that were clinically significant. Patients with CT or MRI abnormal findings had either neurological or ophthalmological complaints as well. For every increase of 10 years in age, the chance of having a CT scan went up 1.41 times. A single CT scan was $1,220; total charges for 810 cases were $988,200. MRI charges were $2,696 per study; total charges for the 90 cases were $242,640. Limitations included possible selection bias from use of a specific HMO and possible underreporting of patients with abnormal radiological findings due to use of ICD-9 codes.
Bottom line: CT and MRI of the head in all patients presenting to the ED is not helpful in identifying the cause of dizziness and is not cost effective.
Citation: Ahsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M. The costs and utility of imaging in evaluating dizzy patients in the emergency room. Laryngoscope. 2013;123:2250-2253.
—Reviewed by Amy Eckner
Combined Use of EEA and TORS Effective for Skull Base Surgery
Are current robotic approaches to skull base surgery effective?
Background: Skull base surgery can be difficult and complex, given the presence of nearby vital structures. Endoscopic endonasal approaches (EEAs) are a surgical alternative for treating benign and malignant sinonasal tract and skull base lesions that can provide exposure to neurovascular structures. Robotic-assisted surgery (TORS) can also facilitate complex surgeries in difficult-to-access areas of the upper aerodigestive tract.