Case series of vestibular schwannoma patients with no asymmetry in hearing

Kellermeyer, Brian; Haught, Erica; Harper, Tyler; Wetmore, Stephen J.

doi:10.1016/j.amjoto.2021.103034

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…However, the patient with a tumor size of 24 mm had severe unilateral SNHL and required surgery. This is consistent with other studies (4,28), which revealed that at the time of diagnosis, VS patients without hearing loss had, on average, smaller tumor sizes. The increased use of conservative management, together with the small tumor sizes in our patient sample, raises additional concerns about the value of further investigation in this group.…”

Section: Discussionsupporting

confidence: 93%

“…Hearing loss and tinnitus are two of the most common symptoms, affecting 95% and 63% of patients with VS, respectively (4). If these tumors continue to grow, they can damage surrounding intracranial structures because of mass effect, causing neurological symptoms such as trigeminal and facial nerve impairment and, in extreme cases, hydrocephalus or brain stem compression (5).…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Vestibular Schwannoma in Patients with Unilateral Tinnitus: A Systematic Review and Meta-Analysis

Javed,

Okoh,

Mughal

et al. 2023

Otol Neurotol

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Objectives Vestibular schwannoma (VS) is a tumor of the vestibulocochlear nerve. Current literature indicates that 1.6% of patients undergoing magnetic resonance imaging of the internal auditory meatus (MRI IAM) for audiovestibular symptoms are diagnosed with a VS. However, there is limited research reporting on patients who present with unilateral tinnitus without asymmetrical hearing loss. This study is a systematic review and meta-analysis evaluating how many of those patients had a VS diagnosed on MRI IAM. Databases Used Online searches of PubMed, Medline, and Embase databases were performed up to October 2022. Methods This meta-analysis was undertaken aligning with PRISMA guidelines. Articles reporting on patients having MRI IAM for unilateral tinnitus without asymmetrical hearing loss were included. Outcomes measures were patient demographics, VS cases, incidental findings, size, and management of tumor. A meta-analysis of proportions was performed using a random-effects model with the restricted maximum likelihood method. Quality assessment was performed using the Joanna Briggs Institute critical appraisal checklist. Results Seven case series were included in the review: a total of 1,394 patients. Seven patients had a VS, with a median size of 4 mm. The pooled detection rate for VS was 0.08% (95% confidence interval = 0.00–0.45). Subsequent management was reported in six cases of which four were actively monitored and two surgically excised. The most common incidental finding was sinus disease (49 patients). Conclusion Our findings indicate that MRI IAM has a low diagnostic yield for VS detection in patients presenting with unilateral tinnitus without asymmetrical hearing loss, with mostly small tumors that are conservatively managed.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Incidence of Vestibular Schwannoma in Patients with Unilateral Tinnitus: A Systematic Review and Meta-Analysis

Javed,

Okoh,

Mughal

et al. 2023

Otol Neurotol

View full text Add to dashboard Cite

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“…Gradual, high-tone hearing loss with higher asymmetry in the frequency range of 2–8 kHz is a typical characteristic of VS [ 3 ]. Headaches, visual changes, hypoesthesia, and palsies are just a few of the additional symptoms that could manifest as a result of a VS [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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(1) Background: Magnetic resonance imaging (MRI) is the gold standard investigation for all patients who present with asymmetrical hearing loss (AHL) and a high index of suspicion for vestibular schwannoma (VS). However, pure-tone audiometry (PTA) is an investigation that can be used for the screening of these patients in order to reduce the costs. The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of different PTA protocols for VS in patients with ASHL, when compared with MRI; (2) Methods: Medline, Embase, and Cochrane databases were used to find relevant studies. All prospective and retrospective observational studies that evaluated the accuracy of PTA protocols for the screening of VS were assessed, according to the international guidelines; (3) Results: We analyzed seven studies (4369 patients) of poor-to-moderate quality. Their pooled sensitivity was good (0.73–0.93), but their specificity was low (0.31–0.60). All protocols were located in the right lower quadrant on the likelihood scattergram, and the post-test probabilities for positive and negative diagnosis of these protocols were extremely low; (4) Conclusions: PTA protocols cannot be used for a proper screening or diagnosis of vestibular schwannoma despite their good sensibility, and MRI remains the gold standard for this purpose.

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“…Vestibular schwannomas are benign lesions that lead to a myriad of progressive symptoms, including hearing loss, dizziness, tinnitus, and headaches. [1][2][3] An apoplectic event (i.e., intratumoral hemorrhage) is rare but can lead to sudden onset of vestibular symptoms, hearing loss, and facial numbness. 4,5 Management typically involves resection of the tumor with the goal of functional preservation of facial nerve function.…”

mentioning

confidence: 99%

Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case

Avalos

Morshed

Goldschmidt

2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Acute intratumoral hemorrhage within a vestibular schwannoma, or vestibular apoplexy, is a rare condition. Unlike the typical insidious vestibulopathy typically caused by vestibular schwannoma growth, patients with vestibular apoplexy have an acute and severe presentation with nausea and emesis in addition to severe vertigo and hearing loss. Here, the authors present an illustrative case demonstrating this rare clinical condition and an operative video detailing the surgical management. OBSERVATIONS A 76-year-old man presented to the emergency department with acute-onset dizziness, left-ear fullness, double vision, gait ataxia, emesis, and facial numbness. Imaging revealed a 2.8-cm hemorrhagic left cerebellopontine angle lesion extending into the left internal auditory canal, consistent with hemorrhagic vestibular schwannoma. The patient subsequently underwent a retrosigmoid craniotomy for resection of the hemorrhagic mass, and by 1 month after surgery, all his presenting symptoms had resolved, allowing his return to daily activities. LESSONS Vestibular schwannomas typically present with decreased hearing and chronic vestibulopathy. Acute presentation should raise the suspicion for an apoplectic event, and surgical debulking may lead to improvement in most vestibular symptoms.

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Case series of vestibular schwannoma patients with no asymmetry in hearing

Cited by 4 publications

References 22 publications

Incidence of Vestibular Schwannoma in Patients with Unilateral Tinnitus: A Systematic Review and Meta-Analysis

Incidence of Vestibular Schwannoma in Patients with Unilateral Tinnitus: A Systematic Review and Meta-Analysis

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

Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case

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