Vestibular schwannoma: when to look for it?

J Laryngol Otol. 2010 Mar;124(3):258-64. doi: 10.1017/S0022215109991423. Epub 2009 Nov 19.

Abstract

Objectives: (1) To compare audiometric parameters in patients with vestibular schwannoma and in those with asymmetric hearing loss from other causes; and (2) to assess proposed screening criteria by comparing published protocols.

Methods: Audiometric data from 199 vestibular schwannoma patients and 225 non-tumour patients were compared. Eight screening protocols were tested on these 424 patients.

Results: Vestibular schwannoma and non-tumour patients with little or no hearing loss in the unaffected ear were inseparable; however, vestibular schwannoma patients with hearing loss in the unaffected ear had greater audiometric asymmetry, compared with non-tumour patients with the same pattern of hearing loss. The sensitivity of screening protocols varied from 73 to 100 per cent; parallelism was observed between sensitivity and screening rate.

Conclusion: As regards vestibular schwannoma screening protocols, the best compromise between sensitivity and screening rate was offered by a criterion comprising either: (1) > or =20 dB asymmetry at two neighbouring frequencies, or unilateral tinnitus, or (2) > or =15 dB asymmetry at two frequencies between 2 and 8 kHz.

MeSH terms

  • Aged
  • Audiometry*
  • Denmark
  • Female
  • Hearing Loss, Sensorineural / diagnosis
  • Hearing Loss, Sensorineural / etiology
  • Hearing Loss, Sensorineural / physiopathology
  • Hearing Loss, Unilateral / diagnosis*
  • Hearing Loss, Unilateral / etiology
  • Hearing Loss, Unilateral / physiopathology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neuroma, Acoustic / diagnosis*
  • Neuroma, Acoustic / physiopathology
  • Patient Selection
  • Sensitivity and Specificity
  • Sex Distribution
  • Speech Discrimination Tests
  • Stapedius / physiology
  • Tinnitus / etiology