All identified studies had a moderate-to-high risk of bias, and none of the currently available non-imaging screening protocols appear to be accurate in detecting VSs.

Objectives Patients with a vestibular schwannoma (VS) experience a reduced quality of life (QoL). The main objective of this study was to determine the strongest predictors reducing physical and mental QoL from the disease‐specific Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire in patients with VS. Design Observational study. Setting Radboudumc Skull Base Centre, Nijmegen. Participants Patients newly diagnosed with VS between 2014 and 2017 managed with either observation, stereotactic radiosurgery or microsurgery. Main outcome measures Quality of life was assessed using the disease‐specific PANQOL and general Short‐Form (36) Health Survey (SF‐36). Multiple linear regression models with PANQOL domains as predictors were used to determine the strongest predictors for SF‐36 QoL physical and mental health scores. Standardised beta coefficients (β) were used for ranking. Results A total of 174 patients (50% females, mean age 58.9 years) returned the questionnaires, providing a 69% response rate. Fifteen patients (9%) were treated with microsurgery, 29 (17%) with stereotactic radiosurgery and 130 patients (75%) were observed in a wait and scan strategy. A lack of energy (β = .28; P ≤ .001), lower general health (β = .22; P ≤ .001), headache (β = .16; P ≤ .001), anxiety (β = .15; P ≤ .001) and balance problems (β = .10; P ≤ .001) are the strongest predictors affecting physical health, while mental health is most affected by anxiety (β = .37; P ≤ .001), a lack of energy (β = .34; P ≤ .001), facial nerve dysfunction (β = .07; P ≤ .001), balance problems (β = .04; P ≤ .001) and headaches (β = .04; P ≤ .001). Conclusion A lack of energy, anxiety, headache and balance problems are the strongest predictors of both SF‐36 physical and mental QoL in patients with VS. More awareness and supportive care regarding energy, anxiety, headache and balance in informing, evaluating and treating patients with VS could improve QoL.

ObjectiveTo compare international diagnostic and management strategies for vestibular schwannoma (VS).MethodsA web-based questionnaire was sent to 130 otolaryngologists, mainly identified through the European Skull Base Society. It contained questions on general information including guideline usage as well as questions on diagnosis (focussing on selection of patients for MRI) and management of VS, including case scenarios. Descriptive statistics were reported.ResultsThirty-six otolaryngologists working in 11 different countries completed the questionnaire (response rate: 28%). Guidelines for diagnosis and management of VS are used by 44% and 42% of respondents, respectively. In the diagnostic strategy for VS, different types and combinations of audiovestibular function tests are used when deciding whether a patient should undergo an MRI. Respondents apply 18 different definitions of asymmetrical hearing loss. Variation was also apparent from reported considerations on management of VS. Most respondents (84%) prefer a wait-and-scan strategy in case of a small intrameatal VS (Koos 1). Variety in management strategies increases for patients with a medium to large sized VS (Koos 2, 3 and 4). The details of each management strategy (wait-and-scan, microsurgery, stereotactic radiosurgery and fractionated radiotherapy) also differ among respondents.ConclusionsA large variation in diagnostic and management strategies for VS was identified between respondents. More evidence and/or consensus seem warranted to reduce uncertainties for patients, and differences in outcome and costs that might result from the variety of strategies currently being applied.Electronic supplementary materialThe online version of this article (10.1007/s00405-018-5199-6) contains supplementary material, which is available to authorized users.

Objectives: To develop a prediction model to predict vestibular schwannoma (VS) growth for patients in a wait and scan (W&S) strategy. Design: Retrospective cohort study. Setting: Tertiary hospital (Radboud university medical center, Nijmegen, the Netherlands). Participants: Patients with unilateral VS, entering a W&S strategy and at least one follow-up MRI available. Data on demographics, symptoms, audiometry and MRI characteristics at time of diagnosis were collected from medical records. Main outcome measures: Following multiple imputation, a multivariable Cox regression model was used to select variables, using VS growth (≥2 mm) as outcome. Decision curve analyses (DCA) were performed to compare the model to the current strategy.

Although there is insufficient high-quality evidence regarding the diagnostic value of the Carhart notch, it seems it is a useful hint for the presence of otosclerosis, but it cannot be used to confirm a diagnosis of otosclerosis.