Multiple Audiometric Analysis in the Screening of Vestibular Schwannoma

Abstract

Introduction Asymmetric sensorineural hearing loss is the main early symptom of retrocochlear lesions, hence its importance in screening for vestibular schwannomas. Currently, there is no consensus regarding its definition. The objective was to identify the audiometric pattern that would serve as a predictor for vestibular schwannoma in patients with asymmetric hearing loss. Materials and methods A cross-sectional study was conducted that included patients with asymmetric hearing loss attending a secondary care center and a tertiary care center. Clinical, audiometric and imaging (MRI with gadolinium) variables were collected. Asymmetric hearing loss was defined as a difference of 15 dB in one or more frequencies between both ears. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of different audiometric patterns were analyzed. Results A total of 107 patients were studied and divided into two groups: group 1 without vestibular schwannoma (n=98); and group 2 with vestibular schwannoma (n=9). No significant difference in demographic characteristics or audiometric patterns was found in patients with and without vestibular schwannoma. The audiometric pattern with the best sensitivity as a screening test was a difference >20 dB in the 4,000 Hz frequency, with a sensitivity of 77.78%, specificity of 30.61%, PPV of 8.33%, NPV of 93.75% and accuracy of 34.50%. Conclusion The audiometric pattern with the best results was a difference >20 dB in the 4,000 Hz frequency range; however, patients with asymmetric hearing loss could not be differentiated from patients with retrocochlear lesions based only on audiometry. Asymmetrical hearing loss must be studied with MRI.

The Diagnostic Accuracy of Pure-Tone Audiometry Screening Protocols for Vestibular Schwannoma in Patients with Asymmetrical Hearing Loss—A Systematic Review and Meta-Analysis

“…Overall, the quality of included studies was low-to-moderate ( Table 2 ). Two studies found a high risk of bias in one domain (patient selection) [ 24 , 25 ]. For the rest of the domains, the risk of bias was assessed as low and unclear.…”

“…The highest pooled sensitivity was achieved by the following protocols: Mangham 0.93 (95% CI: 0.76–0.98) [ 18 , 21 , 23 , 24 , 25 ], Amclass 0.93 (95% CI: 0.89–0.95) [ 18 , 22 , 23 , 24 , 25 ], and Nashville 0.91 (95% CI: 0.86–0.94) [ 18 , 20 , 22 , 24 , 25 ], while the highest pooled specificity and pooled positive likelihood ratio was achieved by the American Academy of Otolaryngology protocol (AAO) at 0.60 (95% CI: 0.49–0.70) and 2.1 (95% CI: 1.6–2.9) [ 18 , 20 , 22 , 23 , 24 , 25 ].…”

“…The highest pooled negative likelihood ratio corresponded to the Sheppard protocol 0.45 (95% CI: 0.24–0.85) [ 18 , 21 , 23 , 25 ], and the highest pooled diagnostic odds ratio was attributed to the Mangham protocol 9 (95% CI: 2–55) [ 18 , 21 , 23 , 24 , 25 ].…”

“… Meta-analysis of Department of Health protocol. ( a ) Forrest plot of pooled sensitivity and specificity [ 8 , 10 , 22 , 23 , 24 , 25 ]; ( b ) Hierarchical summary receiver operating characteristic (HSROC) curve; ( c ) Likelihood ratio scattergram; ( d ) Fagan nomogram. …”