Vestibular schwannoma in patients with asymmetric sensorineural hearing loss: when to screen for it?
DOI:
https://doi.org/10.34631/sporl.2198Keywords:
vestibular schwannoma, asymmetric sensorineural hearing loss, screening, retrocochlear pathology, magnetic resonance imagingAbstract
Objectives: (1) To compare clinical and audiometric parameters between patients with vestibular schwannoma (VS) and patients with asymmetric sensorineural hearing loss (ASNHL) of unknown etiology; (2) to evaluate proposed protocols for VS screening.
Study Design: Retrospective and cross-sectional.
Materials and Methods: Demographic, clinical, and audiometric data were analyzed and compared in 208 patients with ASNHL with and without VS on MRI. The sensitivity, specificity, and accuracy of different protocols for VS screening were analyzed.
Results: Eighteen patients (8.3%) had VS. Female gender, absence of smoking, unilateral tinnitus, facial sensory and motor symptoms, positive head impulse test (HIT), and suggestive auditory brainstem response (ABR) results were significantly more associated with the VS group. Audiometric asymmetry was greater at 4 kHz in patients with VS. Analysis of a new proposed protocol with clinical and audiometric criteria revealed higher sensitivity (94.6%), specificity (46.5%), and accuracy (50.9%) compared to exclusively audiometric protocols evaluated.
Conclusions: In addition to audiometry, this study demonstrated the benefit of including clinical indicators in a new decision protocol for VS screening.
References
Brackmann D, Arriaga M. Neoplasms of the Posterior Fossa. In: Flint PW, Haughey BH, Lund VJ, Robbins KT, Thomas JR, Lesperance MM, et al. Cummings Otolaryngology E-Book. 5ª Ed. Philadelphia: Elsevier Health Sciences; 2020. Volume 3. p. 2514-2540.
Escada P. Schwannoma Vestibular. In Seabra R, Monteiro C, Trigueiros N, Costa S, Subtil J, Lemos J. Otoneurologia. Lisboa: Círculo Médico; 2023. p. 293-298.
Cheng TC, Wareing MJ. Three‐year ear, nose, and throat cross‐sectional analysis of audiometric protocols for magnetic resonance imaging screening of acoustic tumors. Otolaryngol Head Neck Surg. 2012 Mar;146(3):438-47. doi: 10.1177/0194599811427384
Celis-Aguilar E, Obeso-Pereda A, Castro-Bórquez KM, Dehesa-Lopez E, Vega-Alarcon A, Coutinho-De Toledo H. Multiple audiometric analysis in the screening of vestibular schwannoma. Cureus. 2022 Jan 22;14(1):e21492. doi: 10.7759/cureus.21492.
Bhargava EK, Coyle P, Wong B, Masood A, Qayyum A. To scan or not to scan—a cross-sectional analysis of the clinical efficacy and cost-effectiveness of audiometric protocols for magnetic resonance imaging screening of vestibular schwannomas. Otol Neurotol. 2019 Jun;40(5S Suppl 1):S59-S66. doi: 10.1097/MAO.0000000000002215.
Waterval J, Kania R, Somers T. EAONO position statement on vestibular schwannoma: imaging assessment. What are the indications for performing a screening MRI scan for a potential vestibular schwannoma? J Int Adv Otol. 2018 Apr;14(1):95-99. doi: 10.5152/iao.2018.5364.
Ahsan SF, Standring R, Osborn DA, Peterson E, Seidman M, Jain R. Clinical predictors of abnormal magnetic resonance imaging findings in patients with asymmetric sensorineural hearing loss. JAMA Otolaryngol Head Neck Surg. 2015 May 1;141(5):451-6. doi: 10.1001/jamaoto.2015.142.
Saliba I, Martineau G, Chagnon M. Asymmetric hearing loss: rule 3,000 for screening vestibular schwannoma. Otol Neurotol. 2009 Jun;30(4):515-21. doi: 10.1097/MAO.0b013e3181a5297a.
Cueva RA. Auditory brainstem response versus magnetic resonance imaging for the evaluation of asymmetric sensorineural hearing loss. Laryngoscope. 2004 Oct;114(10):1686-92. doi: 10.1097/00005537-200410000-00003.
- Dawes PJ. Vestibular schwannoma screening: closing the audit loop. J Laryngol Otol. 2001 Sep;115(9):719-22. doi: 10.1258/0022215011908973.
Gimsing S. Vestibular schwannoma: when to look for it? J Laryngol Otol. 2010 Mar;124(3):258-64. doi: 10.1017/S0022215109991423.
Kim S, Lee Y-H, Park S, Jeong J, Chang K-H. Incidence and risk factors of vestibular schwannoma in Korea: a population-based study. J Korean Neurosurg Soc. 2023 Jul;66(4):456-464. doi: 10.3340/jkns.2022.0203.
Vu Q-N, Ko E, Wisniewski SJ, Carpenter G, Laur H, Shermetaro C. Correlation of clinical factors and audiometric characteristics with MRI findings in patients with asymmetric sensorineural hearing loss. Spartan Med Res J. 2018 Sep 26;3(2):7005. doi: 10.51894/001c.7005.
Canha Dentinho J, São Pedro R, Polainas S, Fidalgo Alves S, Mendes R, Antunes L. A Média de 2 e 4 kHz prediz segurança o limiar de 3 kHz? Port J ORL 2021 Jun; 59(2): 87-91. doi.org/10.34631/sporl.866.
Hosoya M, Wakabayashi T, Wasano K, Nishiyama T, Tsuzuki N, Oishi N. Understanding the molecular mechanism of vestibular schwannoma for hearing preservation surgery: otologists’ perspective from bedside to bench. Diagnostics (Basel). 2022 Apr 21;12(5):1044. doi: 10.3390/diagnostics12051044.
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