Development of a diagnostic model to identify patients at high risk for cerebellopontine angle lesions

Purpose: To develop a diagnostic model to identify patients at high risk of a CPA lesion.

Methods: A consecutive cohort of patients with AAD referred by a general practitioner, who underwent their first MRI examination of the CPA between 2005 and 2015 was included. Demographics, symptoms, findings during physical examination, and pure-tone audiometry were used as potential predictors. The presence of a CPA lesion was used as outcome.

Results: We analyzed data of 2,214 patients, detecting 73 CPA lesions in 69 (3.1%) patients. The final model contained eleven variables, namely gender [male] [OR 1.055 (95% CI 0.885-1.905)], sudden onset of hearing loss [OR 0.768 (95% CI 0.318-0.992)], gradual onset of hearing loss [OR 1.069 (95% CI 0.500-1.450)], unilateral tinnitus [OR 0.682 (95% CI 0.374-0.999)], complaints of unilateral aural fullness [OR 1.006 (95% CI 0.783-2.155)], instability [OR 1.006 (95% CI 0.580-2.121)], headache [OR 0.959 (95% CI 0.059-1.090)], facial numbness [OR 2.746 (95% CI 0.548-11.085)], facial nerve dysfunction during physical examination [OR 1.024 (95% CI 0.280-3.702)], and asymmetry in BC at 1 kHz [OR 1.013 (95% CI 1.000-1.027)] and 4 kHz [OR 1.008 (95% CI 1.000-1.026)].

Conclusion: The proposed diagnostic model is a first step in selecting patients with a high risk of a CPA lesion among those with AAD. It needs to be externally validated prior to its implementation in clinical practice.