Three‐Year Ear, Nose, and Throat Cross‐sectional Analysis of Audiometric Protocols for Magnetic Resonance Imaging Screening of Acoustic Tumors

Abstract

For optimum sensitivity, the Mangham protocol is preferred (sensitivity, 91.58%; specificity A, 44.23%; specificity B, 44.91%), which proposes a ≥10-dB interaural difference, averaging 1 to 8 kHz. For optimum specificity, the American Academy of Otolaryngology-Head and Neck Surgery protocol is preferred (sensitivity, 87.37%; specificity A, 65.38%; specificity B, 66.04%), which proposes ≥15 dB between ears, averaging 0.5 to 3 kHz.

The diagnostic accuracy of non‐imaging screening protocols for vestibular schwannoma in patients with asymmetrical hearing loss and/or unilateral audiovestibular dysfunction: a diagnostic review and meta‐analysis

“…It would be ideal to use a relatively simple, low‐cost test as a first screening tool for VS, such as PTA. Most screening protocols published in this review make use of PTA as a screening tool . Based on the pooled results from this meta‐analysis, AAO‐HNS, Obholzer 1 and Sunderland protocols appeared to have highest sensitivities in detecting VS, but all three have poor specificities .…”

“…[13][14][15][16][17] The incidence of VS ranged from 1.4% to 39.6% in the included cohort studies. 13,[16][17][18][19][20] Most other studies were case-control studies. Several authors studied multiple screening protocols in their study population.…”

“…Several authors studied multiple screening protocols in their study population. 14,15,17,18,21,22 Six studies used PTA as index test, comprising 3116 patients. 14,[17][18][19]21,22 Five of these 14,17,18,21,22 tested specific PTA protocols (hearing thresholds at different frequencies) that had been published before in 2616 patients, and two 14,19 tested different PTA shapes (description of the PTA shape without providing specific thresholds, e.g.…”

Hearing disorders in brainstem lesions

“…Although MRI has a clear role in the diagnosis of retrocochlear hearing disorders, its high cost precludes its use as a screening test. Cheng and Wareing (2012) reported the MRI findings in 7494 cases of sensorineural hearing disorders "across ENT clinics" and noted that MRIs were abnormal in 2088 (27.8%) patients, including 284 (3.8%) vestibular schwannomas and 209 (2.8%) ischemic infarcts. Similarly, in sudden cases of hearing loss the diagnostic yield of MRI is low, varying from 4% to 34.5%.…”

“…with vestibular schwannomas representing only 2.5-3.8% of all cases (Fitzgerald and Mark, 1998;Stokroos et al, 1998;Schick et al, 2001;Cadoni et al, 2006;Chau et al, 2010). Because of this low diagnostic yield and high cost, the need has arisen to formulate guidelines as part of "decision making for MRI screening of acoustic tumors" (Cheng and Wareing, 2012) and other unilateral SNHL. In Figure 29.7 we propose an algorithm for patients presenting with unilateral hearing loss based on an audiometric protocol.…”