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Schiff E, Friedman SA, Al-Mulki K, Lin J, Moskowitz HS. Practice Patterns in Asymmetric Sensorineural Hearing Loss: Survey Data. Laryngoscope 2024. [PMID: 38877834 DOI: 10.1002/lary.31573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/20/2024] [Accepted: 05/31/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE Although screening protocols for patients who present with asymmetric sensorineural hearing loss (ASNHL) exist, there are no clear guidelines to direct practitioners. In particular, various thresholds have been proposed for the degree of hearing loss that should prompt MRI studies, but the topic remains understudied. This project aims to compare protocols followed by practitioners to guide their imaging practices. STUDY DESIGN Web-based survey. SETTING Otolaryngology faculty at academic medical centers. METHODS A list of 530 otolaryngologists (276 otology/neurotology specialists, 254 general otolaryngologists) was compiled. A survey consisting of three parts: demographics, general practice patterns, and simulated patient cases was distributed. RESULTS A total of 468 surveys were successfully distributed, resulting in 88 (18.8%) responses. The majority of respondents (63.8%) self-reported their definition of ASNHL as ">30 dB hearing asymmetry at one frequency OR >20 dB hearing asymmetry at two continuous frequencies OR >10 dB hearing asymmetry at three contiguous frequencies." Overall, general otolaryngologists were more likely to observe asymmetric findings with serial audiogram alone, whereas otology/neurotology specialists were more likely to obtain imaging. CONCLUSION There is significant variability between providers with regard to managing patients with ASNHL and evidence-based guidelines would be useful in guiding imaging practices. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
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Affiliation(s)
- Elliot Schiff
- Albert Einstein College of Medicine, New York, New York, U.S.A
| | - Sara A Friedman
- Albert Einstein College of Medicine, New York, New York, U.S.A
| | - Kareem Al-Mulki
- Albert Einstein College of Medicine, New York, New York, U.S.A
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, New York, New York, U.S.A
| | - Juan Lin
- Albert Einstein College of Medicine, New York, New York, U.S.A
| | - Howard S Moskowitz
- Albert Einstein College of Medicine, New York, New York, U.S.A
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, New York, New York, U.S.A
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2
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Tsai Do BS, Bush ML, Weinreich HM, Schwartz SR, Anne S, Adunka OF, Bender K, Bold KM, Brenner MJ, Hashmi AZ, Keenan TA, Kim AH, Moore DJ, Nieman CL, Palmer CV, Ross EJ, Steenerson KK, Zhan KY, Reyes J, Dhepyasuwan N. Clinical Practice Guideline: Age-Related Hearing Loss. Otolaryngol Head Neck Surg 2024; 170 Suppl 2:S1-S54. [PMID: 38687845 DOI: 10.1002/ohn.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. PURPOSE The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life (QOL). (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related QOL at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.
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Affiliation(s)
| | - Matthew L Bush
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | | | | | | | - Kaye Bender
- Mississippi Public Health Association, Jackson, Mississippi, USA
| | | | | | | | | | - Ana H Kim
- Columbia University Medical Center, New York, New York, USA
| | | | - Carrie L Nieman
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | - Joe Reyes
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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3
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Tsuzuki N, Kitama T, Wasano K, Wakabayashi T, Hosoya M, Nishiyama T, Ozawa H, Oishi N. Characteristics of pure tone audiogram in patients with untreated sporadic vestibular schwannoma: Analysis of audiometric shape and interaural differences stratified by age and mode of onset. Auris Nasus Larynx 2024; 51:347-355. [PMID: 37788966 DOI: 10.1016/j.anl.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Asymmetric sensorineural hearing loss (ASHL) is the most common symptom of sporadic vestibular schwannoma (VS). However, there is still no universally accepted MRI protocol for diagnosing VS. This study identified the characteristics of pure tone audiogram (PTA) in patients with VS. METHODS We conducted a retrospective chart review of patients diagnosed with sporadic unilateral VS. In the analysis, we focused on the shape and interaural differences of PTA, stratified by the mode of onset and patient age. RESULTS In total, 390 patients met the inclusion criteria. The U-shaped audiogram showed the highest proportion in patients with the onset of sudden sensorineural hearing loss (SSNHL). In patients with SSNHL, U-shaped audiograms were younger than other audiograms, and 86.7 % of patients under 40 had U-shaped audiograms. Patients with VS were more likely to have interaural differences at higher frequencies than at lower frequencies. Patients with SSNHL had a significantly higher percentage of interaural differences at 500-4000 Hz than those with onset other than SSNHL (non-SSNHL patients). In addition, non-SSNHL patients had a significant trend toward a higher percentage of interaural differences at all frequencies with increasing age. CONCLUSION MRI screening can be considered in patients with SSNHL with U-shaped audiograms under 40 years of age. In ASHL, not SSNHL, MRI screening can be considered for older patients with interaural differences at wider continuous frequencies. Patients with interaural differences at high frequencies had a higher priority than those with interaural differences at low frequencies as indications for MRI screening for VS.
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Affiliation(s)
- Nobuyoshi Tsuzuki
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro, Tokyo 152-8902, Japan; Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro, Tokyo 152-8902, Japan
| | - Tsubasa Kitama
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Koichiro Wasano
- Department of Otolaryngology, Head and Neck Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara-city, Kanagawa 259-1193, Japan
| | - Takeshi Wakabayashi
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Takanori Nishiyama
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Hiroyuki Ozawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Naoki Oishi
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
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Nowacka A, Barker-Collo S, Miles A. Exploring the influence of appearance evaluation apprehension: How fear of negative evaluation affects quality of life in people with Vestibular Schwannoma. J Clin Neurosci 2024; 123:7-12. [PMID: 38508019 DOI: 10.1016/j.jocn.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
People diagnosed with Vestibular Schwannoma (VS) can experience several symptoms both pre and post-treatment. These, alongside the diagnosis experience, can significantly impact their daily life. The present research is a continuation of a larger study aiming to explore the impacts of symptomology and body image/fear of negative evaluation (FNAE) on the quality of life (QOL) for people with VS. The research design was exploratory and involved a nationwide survey with a total of 52 participants. FNAE was assessed using a measurement of the same name, and QOL was assessed using the Penn Acoustic Neuroma Quality of Life scale (PANQOL). Comparing management groups revealed a significant difference in FNAE with higher scores for surgery compared to radiation treatment. Regression analyses revealed that FNAE significantly accounted for 10.9% of the variance in QOL. However, no symptom was significantly predictive of FNAE. In conclusion, VS is associated with several symptoms that can persist post-treatment. Body satisfaction contributes to QOL and may differ between management types. However, due to inconclusive findings on the predictability of symptoms on FNAE, other moderator factors could influence these direct relationships. Future studies should evaluate the variables that could mitigate or protect from the impacts of FNAE for this population.
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Affiliation(s)
- Alicja Nowacka
- School of Psychology, The University of Auckland, Auckland, New Zealand.
| | - Suzanne Barker-Collo
- Clinical Training Programme, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
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5
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Silva VAR, Lavinsky J, Pauna HF, Vianna MF, Santos VM, Ikino CMY, Sampaio ALL, Tardim Lopes P, Lamounier P, Maranhão ASDA, Soares VYR, Polanski JF, Denaro MMDC, Chone CT, Bento RF, Castilho AM. Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101313. [PMID: 37813009 PMCID: PMC10563065 DOI: 10.1016/j.bjorl.2023.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE To review the literature on the diagnosis and treatment of vestibular schwannoma. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. CONCLUSIONS Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO
| | - Joel Lavinsky
- Sociedade Brasileira de Otologia - SBO; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Melissa Ferreira Vianna
- Sociedade Brasileira de Otologia - SBO; Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Hospital Universitário, Departamento de Cirurgia, Florianópolis, SC, Brazil
| | - André Luiz Lopes Sampaio
- Sociedade Brasileira de Otologia - SBO; Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Paula Tardim Lopes
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Pauliana Lamounier
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), Departamento de Otorrinolaringologia, Goiânia, GO, Brazil
| | - André Souza de Albuquerque Maranhão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Vitor Yamashiro Rocha Soares
- Hospital Flavio Santos e Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackenzie do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil
| | | | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Ricardo Ferreira Bento
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO.
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6
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Jain V, Policeni B, Juliano AF, Adunka O, Agarwal M, Dubey P, Friedman ER, Gule-Monroe MK, Hagiwara M, Hunt CH, Lo BM, Oh ES, Rath TJ, Roberts JK, Schultz D, Taheri MR, Zander D, Burns J. ACR Appropriateness Criteria® Tinnitus: 2023 Update. J Am Coll Radiol 2023; 20:S574-S591. [PMID: 38040471 DOI: 10.1016/j.jacr.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Tinnitus is abnormal perception of sound and has many subtypes. Clinical evaluation, audiometry, and otoscopy should be performed before ordering any imaging, as the choice of imaging will depend on various factors. Type of tinnitus (pulsatile or nonpulsatile) and otoscopy findings of a vascular retrotympanic lesion are key determinants to guide the choice of imaging studies. High-resolution CT temporal bone is an excellent tool to detect glomus tumors, abnormal course of vessels, and some other abnormalities when a vascular retrotympanic lesion is seen on otoscopy. CTA or a combination of MR and MRA/MRV are used to evaluate arterial or venous abnormalities like dural arteriovenous fistula, arteriovenous malformation, carotid stenosis, dural sinus stenosis, and bony abnormalities like sigmoid sinus wall abnormalities in cases of pulsatile tinnitus without a vascular retrotympanic lesion. MR of the brain is excellent in detecting mass lesions such as vestibular schwannomas in cases of unilateral nonpulsatile tinnitus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio.
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Oliver Adunka
- The Ohio State University Wexner Medical Center, Columbus, Ohio; American Academy of Otolaryngology-Head and Neck Surgery
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Mari Hagiwara
- New York University Langone Medical Center, New York, New York
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Esther S Oh
- Johns Hopkins University School of Medicine, Baltimore, Maryland; American Geriatrics Society
| | | | - J Kirk Roberts
- Columbia University Medical Center, New York, New York; American Academy of Neurology
| | - David Schultz
- Evansville Primary Care, Evansville, Indiana; American Academy of Family Physicians
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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7
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Gheorghe L, Negru D, Cobzeanu MD, Palade OD, Botnariu EG, Cobzeanu BM, Cobzeanu ML. The Diagnostic Accuracy of Pure-Tone Audiometry Screening Protocols for Vestibular Schwannoma in Patients with Asymmetrical Hearing Loss-A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12112776. [PMID: 36428836 PMCID: PMC9689241 DOI: 10.3390/diagnostics12112776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
(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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Affiliation(s)
- Liliana Gheorghe
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
| | - Dragos Negru
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
| | - Mihail Dan Cobzeanu
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
| | - Octavian Dragos Palade
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
- Correspondence: (O.D.P.); (E.G.B.)
| | - Eosefina Gina Botnariu
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Correspondence: (O.D.P.); (E.G.B.)
| | - Bogdan Mihail Cobzeanu
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Maria-Luiza Cobzeanu
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
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Abstract
OBJECTIVE The aim of this study is to compare machine learning algorithms and established rule-based evaluations in screening audiograms for the purpose of diagnosing vestibular schwannomas. A secondary aim is to assess the performance of rule-based evaluations for predicting vestibular schwannomas using the largest dataset in the literature. STUDY DESIGN Retrospective case-control study. SETTING Tertiary referral center. PATIENTS Seven hundred sixty seven adult patients with confirmed vestibular schwannoma and a pretreatment audiogram on file and 2000 randomly selected adult controls with audiograms. INTERVENTIONS Audiometric data were analyzed using machine learning algorithms and standard rule-based criteria for defining asymmetric hearing loss. MAIN OUTCOME MEASURES The primary outcome is the ability to identify patients with vestibular schwannomas based on audiometric data alone, using machine learning algorithms and rule-based formulas. The secondary outcome is the application of conventional rule-based formulas to a larger dataset using advanced computational techniques. RESULTS The machine learning algorithms had mildly improved specificity in some fields compared with rule-based evaluations and had similar sensitivity to previous rule-based evaluations in diagnosis of vestibular schwannomas. CONCLUSIONS Machine learning algorithms perform similarly to rule-based evaluations in identifying patients with vestibular schwannomas based on audiometric data alone. Performance of established rule-based formulas was consistent with earlier performance metrics, when analyzed using a large dataset.
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9
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Takahashi M, Inagaki A, Aihara N, Murakami S. Acoustic neuromas associated with sudden sensorineural hearing loss. Acta Otolaryngol 2022; 142:415-418. [PMID: 35654404 DOI: 10.1080/00016489.2022.2080862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Several studies have reported sudden sensorineural hearing loss (SHL) as an initial symptom of acoustic neuromas (ANs). AIMS/OBJECTIVES We aimed to retrospectively evaluate the incidence of SHL and the associated rates of post-treatment improvement in patients diagnosed with ANs. MATERIALS AND METHODS We analysed the clinical data of 686 patients with ANs and examined tumour size, correlation with hearing loss, number of episodes of SHL, extent of auditory recovery, and associated audiogram patterns. RESULTS Among 686 enrolled patients with ANs, 232 (86 with intracanalicular and 146 with extrameatal tumours) experienced SHL at some point in their clinical history. The incidence of SHL was not significantly associated with tumour size. Of the 172 patients analysed, 119, 44, and 9 patients experienced one, two, or three or more episodes of SHL, respectively. Confirmed auditory recovery occurred in 61%, 45.3%, and 33.3% of the patients after the first, second, or third or later episodes of SHL, respectively. The audiograms of 78/172 (45.3%) patients showed a typical trough-shaped pattern of hearing loss at medium-level frequencies. CONCLUSIONS AND SIGNIFICANCE Among patients with ANs, 7.7% experienced two or more episodes of SHL. The recovery rate of SHL decreased with each successive occurrence.
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Affiliation(s)
- Mariko Takahashi
- Department of Otolaryngology-Head and Neck Surgery, Aichi Gakuin University School of Dentistry, Nagoya City, Japan
| | | | - Noritaka Aihara
- Department of Neurosurgery, Nagoya City University East Medical Centre, Nagoya City, Japan
| | - Shingo Murakami
- Department of Otolaryngology-Head and Neck Surgery, Nagoya City University East Medical Centre, Nagoya City, Japan
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10
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Celis-Aguilar E, Obeso-Pereda A, Castro-Bórquez KM, Dehesa-Lopez E, Vega-Alarcon A, Coutinho-De Toledo H. Multiple Audiometric Analysis in the Screening of Vestibular Schwannoma. Cureus 2022; 14:e21492. [PMID: 35103228 PMCID: PMC8783613 DOI: 10.7759/cureus.21492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 01/14/2023] Open
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.
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Epidemiology and Diagnostic Characteristics of Vestibular Schwannomas-Does Gender Matter? Otol Neurotol 2021; 41:e1372-e1378. [PMID: 33492815 DOI: 10.1097/mao.0000000000002936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A number of epidemiological studies have reported data on, e.g., tumor size and hearing at diagnosis for patients with a vestibular schwannoma (VS), whereas only a few have touched upon the potential significance of sex. The aim of this report is thus to present gender-specific data on incidence and age, tumor localization, tumor size, and hearing loss at diagnosis. MATERIAL AND METHODS Since 1976, various data for all patients diagnosed with a sporadic VS in Denmark have been entered prospectively into a national database. Data on sex, incidence, age, tumor localization, tumor size, and hearing (discrimination) were extracted for the period 1976 to 2015. RESULTS Over the 40 years, 3,637 cases were diagnosed, of which 1,804 were women (50%) and 1,833 men (50%). For both sexes, an increasing incidence of tumors with a steadily decreasing size was found. Age was increasing and hearing at diagnosis was increasingly better.Previously, women had more extrameatal and thus larger tumors. During the most recent decade, more tumors were found in men and hearing at diagnosis was better for women, whereas age and tumor size were comparable. CONCLUSION The data on gender-specific epidemiology and diagnostic characteristics show varying trends over the 40-year-period spanned. For both sexes, an increasing incidence of tumors with a steadily decreasing size was found. Age is increasing and hearing at diagnosis is increasingly better. More extrameatal and thus larger tumors were previously found in women. Contemporarily, more vestibular schwannomas are found in men and diagnostic hearing is better in women.
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Alsarhan H. Identification of early-stage Meniere's disease as a cause of unilateral tinnitus. J Otol 2021; 16:85-88. [PMID: 33777120 PMCID: PMC7984994 DOI: 10.1016/j.joto.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Meniere's disease (MD) is characterized by episodic symptoms, including vertigo, hearing loss, and tinnitus. Objectives in this study, cases of unilateral tinnitus were investigated for MD. Method Twenty-two patients who presented with chronic unilateral tinnitus on puretone audiograms showing an average threshold better than 25 dB HL and thresholds in the lower frequencies worse than those in the higher frequencies by more than 10 dB were suspected to have early-stage MD and underwent electrocochleography (ECochG). Patients showing ECochG findings conclusive for MD were compared to a control group of patients presenting with chronic unilateral tinnitus on pure-tone audiograms showing an average threshold better than 25 dB and thresholds in the higher frequencies worse than those in the lower frequencies by more than 10 dB. Results Eighteen of the 22 patients included in this study showed elevated summating potential amplitude to action potential amplitude ratios in ECochG (suggestive of endolymphatic hydrops due to MD) and were followed up for 2 months; 14 of them experienced at least two attacks of vertigo or unsteadiness. In contrast, only one patient in the control group reported two or more attacks of vertigo or unsteadiness in the 2 month observation period. The incidence of this finding in the two groups was significantly different. Conclusion Patients with early-stage MD can present with only unilateral tinnitus. Thus, the addition of "pure-tone audiograms showing lower-frequency thresholds worse than higher-frequency thresholds" to the probable MD category in the globally.agreed diagnostic criteria for MD, may be useful.
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Vnencak M, Huttunen E, Aarnisalo AA, Jero J, Liukkonen K, Sinkkonen ST. Evaluation of pure-tone audiometric protocols in vestibular schwannoma screening. J Otol 2020; 16:138-143. [PMID: 34220982 PMCID: PMC8241708 DOI: 10.1016/j.joto.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022] Open
Abstract
The objective was to evaluate the pure-tone audiogram-based screening protocols in VS diagnostics. We retrospectively analyzed presenting symptoms, pure tone audiometry and MRI finding from 246 VS patients and 442 controls were collected to test screening protocols (AAO-HNS, AMCLASS-A/B, Charing Cross, Cueva, DOH, Nashville, Oxford, Rule3000, Schlauch, Seattle, Sunderland) for sensitivity and specificity. Results were pooled with data from five other studies, and analysis of sensitivity, specificity and positive likelihood ratio (LR+) for each protocol was performed. Our results show that protocols with significantly higher sensitivity (AMCLASS-A/B, Nashville) show also significantly lowest specificity, and tend to have low association (positive likelihood ratio, LR+) to the VS. The highest LR+ was found for protocols AAO-HNS, Rule3000 and Seattle. In conclusions, knowing their properties, screening protocols are simple decision-making tools in VS diagnostic. To use the advantage of the highest sensitivity, protocols AMCLASS-A + B or Nashville can be of choice. For more reasonable approach, applying the protocols with high LR+ (AAO-HNS, Rule3000, Seattle) may reduce the overall number of MRI scans at expense of only few primarily undiagnosed VS.
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Affiliation(s)
- Matej Vnencak
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland.,Head and Neck Center, Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, And University of Helsinki, Helsinki, Finland
| | - Elina Huttunen
- Head and Neck Center, Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, And University of Helsinki, Helsinki, Finland
| | - Antti A Aarnisalo
- Head and Neck Center, Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, And University of Helsinki, Helsinki, Finland
| | - Jussi Jero
- Head and Neck Center, Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, And University of Helsinki, Helsinki, Finland
| | - Katja Liukkonen
- Head and Neck Center, Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, And University of Helsinki, Helsinki, Finland
| | - Saku T Sinkkonen
- Head and Neck Center, Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, And University of Helsinki, Helsinki, Finland
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Bruschini L, Canelli R, Morandi A, Cambi C, Fiacchini G, Berrettini S, Forli F. Bone Anchored Hearing Aids for the Treatment of Asymmetric Hearing Loss. J Int Adv Otol 2020; 16:313-317. [PMID: 33136009 DOI: 10.5152/iao.2020.8879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Asymmetric hearing loss is generally defined as a moderate-to-profound hearing loss in the poorer ear and a mild-to-moderate hearing loss in the better ear. Application of a bone conduction hearing aid is one of the possible treatments for the poorer ear in asymmetric hearing loss. However, the device essentially stimulates the contralateral better ear, precluding true binaural hearing. The aim of this paper is to evaluate the application and utility of bone-anchored hearing aids in the treatment of asymmetric hearing loss. MATERIALS AND METHODS We retrospectively evaluated 215 implanted subjects in our clinic and extracted a series of 27 patients affected by asymmetric hearing loss and treated with bone-anchored hearing aids. All 27 subjects had a mixed hearing loss after middle ear surgery. The preoperative and postoperative audiological data of these patients were collected and analyzed. RESULTS The audiological tests showed an improvement in the performance of hearing perception of sound and speech in quiet and noise. Moreover, the subjects have positively answered the questionnaires administered to evaluate subjective benefits. All subscales of the abbreviated profile of hearing aid benefit and speech, spatial, and qualities of hearing scale showed a significant improvement with the device. CONCLUSION Bone-anchored hearing aids are a suitable treatment for asymmetric hearing loss. When other devices cannot be utilized or are not indicated, the bone conduction devices may allow good audiological results.
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Affiliation(s)
- Luca Bruschini
- ENT Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
| | - Rachele Canelli
- ENT Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
| | - Andrea Morandi
- ENT Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
| | - Christina Cambi
- ENT Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
| | - Giacomo Fiacchini
- ENT Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
| | - Stefano Berrettini
- ENT Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
| | - Francesca Forli
- ENT Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
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Starnoni D, Giammattei L, Cossu G, Link MJ, Roche PH, Chacko AG, Ohata K, Samii M, Suri A, Bruneau M, Cornelius JF, Cavallo L, Meling TR, Froelich S, Tatagiba M, Sufianov A, Paraskevopoulos D, Zazpe I, Berhouma M, Jouanneau E, Verheul JB, Tuleasca C, George M, Levivier M, Messerer M, Daniel RT. Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 2020; 162:2595-2617. [PMID: 32728903 PMCID: PMC7550309 DOI: 10.1007/s00701-020-04491-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective. MATERIAL AND METHODS A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management. RESULTS Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed. CONCLUSION The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.
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Affiliation(s)
- Daniele Starnoni
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | | | - Giulia Cossu
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Michael J Link
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Pierre-Hugues Roche
- Department of Neurosurgery, CHU North Hospital, Aix-Marseille University, Marseille, France
| | - Ari G Chacko
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Majid Samii
- Neurosurgery, International Neuroscience Institute, Hannover, Germany
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Michael Bruneau
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Naples, NA, Italy
| | - Torstein R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | | | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Albert Sufianov
- Federal Centre of Neurosurgery, Tyumen, Russian Federation; Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University under Ministry of Health, Tyumen, Russian Federation
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Idoya Zazpe
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, Spain
- Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Moncef Berhouma
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - Jeroen B Verheul
- Department of Neurosurgery and Gamma knife Centre, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Constantin Tuleasca
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5) Ecole Polytechnique Fédérale de Lausanne (EPFL) Lausanne, Lausanne, Switzerland
| | - Mercy George
- ENT Service, Centre Hospitalier Universitaire Vaudois (CHUV); Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marc Levivier
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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Asymmetric sensorineural hearing loss and vestibular schwannoma: when to image? Curr Opin Otolaryngol Head Neck Surg 2020; 28:335-339. [PMID: 32841960 DOI: 10.1097/moo.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We review the literature on the use of audiometric protocols in the guidance of when to obtain MRI for detection of vestibular schwannoma. This discussion will focus on the sensitivity, specificity, and cost-effective analysis of audiometric criteria of asymmetric sensorineural hearing loss (ASNHL) when used to decide when MRI scans should be performed. RECENT FINDINGS The sensitivity for detecting vestibular schwannomas when invoking published audiometric protocols for triggering MRI acquisition in ASNHL ranged from 50 to 100%. Specificity of these protocols ranged from 23 to 83%. Such audiometric protocols are efficient, achieving sensitivity and specificity at these rates while reducing the screening rate to 18 to 35%. The reduced procurement of MRI while using such audiometric protocols is associated with annual cost savings of between 23 and 82%. While no definitive recommendations can be made from this review, some audiometric protocols offer a better balance of sensitivity and specificity than others. SUMMARY Audiometric protocols for triggering MRI acquisition in ASNHL for evaluation of vestibular schwannoma can be both sensitive and specific. These are competitive measures, and so no protocol is both 100% sensitive and specific. Such protocols become less effective in populations with increased incidence of noise-induced hearing loss. Invocation of such audiometric protocols can considerably reduce the annual cost of MRI evaluation for vestibular schwannomas.
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Lee JM, Kim Y, Ji JY, Koo JW, Song JJ. Auditory experience, for a certain duration, is a prerequisite for tinnitus: lessons from subjects with unilateral tinnitus in the better-hearing ear. PROGRESS IN BRAIN RESEARCH 2020; 260:223-233. [PMID: 33637219 DOI: 10.1016/bs.pbr.2020.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Tinnitus has traditionally been considered an otologic disorder; however, recent advances in auditory neuroscience have shifted investigations toward the brain. The Bayesian brain model explains tinnitus as an auditory phantom percept. According to the model, the brain works to reduce environmental uncertainty, and thus the absence of auditory information due to hearing loss may cause auditory phantom percepts, i.e., tinnitus. As in animal studies, our recent human observational study revealed the absence of ipsilesional tinnitus in subjects with congenital single-sided deafness, suggesting that auditory experience is a prerequisite for the generation of tinnitus. Prompted by anecdotal cases, we hypothesized that subjects with acquired hearing loss would not develop tinnitus if their duration of auditory experience was not sufficiently long. We retrospectively enrolled 22 subjects with acquired asymmetric hearing loss and unilateral tinnitus in better ear (TBE). Twenty-two hearing threshold-matched controls with tinnitus in worse ear (TWE) were selected from our database of tinnitus patients. All 22 TBE subjects reported that their acquired hearing loss developed before the age of 20, and the reported duration of auditory deprivation in the ear without tinnitus in the TBE group was significantly longer than that of the TWE group. In other words, the TBE group with limited auditory experience in the worse ear did not develop tinnitus in the worse ear while subjects with enough auditory experiences in the worse ear developed ipsilesional tinnitus in the TWE group. These preliminary results support our hypothesis that both auditory experience itself, and an individually variable critical duration of auditory deprivation, are prerequisites for the generation of tinnitus.
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Affiliation(s)
- Jeon Mi Lee
- Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Yoonjoong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jeong-Yeon Ji
- Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Magnetic resonance imaging for vestibular schwannoma: cost-effective protocol for referrals. The Journal of Laryngology & Otology 2019; 133:948-952. [DOI: 10.1017/s0022215119001981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveVestibular schwannoma is the most common neoplasm in the cerebellopontine angle, and fast spin-echo T2-weighted magnetic resonance imaging is the most sensitive test for diagnosing it. This study evaluated the financial and time costs of unnecessary magnetic resonance imaging referrals before and after the application of a magnetic resonance imaging protocol.MethodA full audit cycle was used for the assessment. The first cycle in January 2012 was retrospective and evaluated the financial impact of current selection criteria for magnetic resonance imaging referral against standard guidelines. The second cycle in January 2014 was prospective after implementation of the protocol.ResultsThere were 46 and 112 patients who had magnetic resonance imaging during first and second cycle, respectively. Of the referrals for magnetic resonance imaging, 65 per cent versus 81 per cent of the referrals were appropriate in the first and second cycles, respectively. The relative risk was reduced from 0.5 to 0.2. The waiting times for magnetic resonance imaging scans improved.ConclusionSelection criteria for magnetic resonance imaging referral are important in reducing waiting times for scans, patient anxiety and conserving trust resources.
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Waterval J, Kania R, Somers T. EAONO Position Statement on Vestibular Schwannoma: Imaging Assessment. What are the Indications for Performing a Screening MRI Scan for a Potential Vestibular Schwannoma? J Int Adv Otol 2019; 14:95-99. [PMID: 29764782 DOI: 10.5152/iao.2018.5364] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jérôme Waterval
- Department of Otorhinolaryngology, Radboud University Medical Center, Netherlands
| | - Romain Kania
- Department of ENT, Lariboisiere University Hospital, APHP, Paris Sorbonne University, Paris, France
| | - Thomas Somers
- Department of ENT, Sint-Augustinus Ziekenhuis, Wilrijk, Antwerp, Belgium
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Herrera M, Berrocal JRG, Arumí AG, Lavilla MJ, Plaza G. Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hebb ALO, Erjavec N, Morris DP, Mulroy L, Bance M, Shoman N, Walling S. Quality of life related to symptomatic outcomes in patients with vestibular schwannomas: A Canadian Centre perspective. Am J Otolaryngol 2019; 40:236-246. [PMID: 30554886 DOI: 10.1016/j.amjoto.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022]
Abstract
Patients with vestibular schwannomas (VS) typically present with hearing loss and tinnitus as well as variable cranial nerve dysfunctions. Surgical resection, stereotactic radiotherapy and/or conservative management employing serial magnetic resonance or computed tomography imaging serve as the main treatment options. Quality of life (QoL) may be impacted by the extent of tumour burden and exacerbated or relieved by treatment. Subjective assessment and quality of life inventories provide valuable information in client centered approaches with important implications for treatment. The intention of QoL measurements affecting VS patients within a clinical setting is to facilitate discussions regarding treatment options and objectively evaluate patient- centered clinical outcomes in a naturalistic setting.
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Affiliation(s)
- Andrea L O Hebb
- Division of Neurosurgery, QEII Halifax Infirmary Site, 3rd Floor, 1796 Summer Street, Halifax, NS B3H 3A7, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada.
| | - Niki Erjavec
- Division of Neurosurgery, QEII Halifax Infirmary Site, 3rd Floor, 1796 Summer Street, Halifax, NS B3H 3A7, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada
| | - David P Morris
- OtolaryngologyHead & Neck Surgery, QEII Dickson Building, 3rd Floor, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada
| | - Liam Mulroy
- Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, Room 2204 Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada
| | - Manohar Bance
- Division of Otology and Neurosciences, University of Cambridge, Box 48, ENT Dept, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom of Great Britain
| | - Nael Shoman
- OtolaryngologyHead & Neck Surgery, QEII Dickson Building, 3rd Floor, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada
| | - Simon Walling
- Division of Neurosurgery, QEII Halifax Infirmary Site, 3rd Floor, 1796 Summer Street, Halifax, NS B3H 3A7, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada
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Durakovic N, Valente M, Goebel JA, Wick CC. What defines asymmetric sensorineural hearing loss? Laryngoscope 2018; 129:1023-1024. [DOI: 10.1002/lary.27504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/26/2018] [Accepted: 07/18/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Nedim Durakovic
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
| | - Michael Valente
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
| | - Joel A. Goebel
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
| | - Cameron C. Wick
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
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West N, Møller MN, Hansen S, Cayé-Thomasen P. Audiovestibular Loss of Function Correlates in Vestibular Schwannomas. J Int Adv Otol 2018; 14:161-165. [PMID: 30100546 DOI: 10.5152/iao.2018.5500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of the present study was to investigate the relationships between tumor size, hearing, and vestibular outcomes in patients with vestibular schwannomas (VSs). MATERIALS AND METHODS Adult patients (n=124) with unilateral extrameatal VS prior to surgery were included in the study. This was a retrospective cohort study of preoperative audiovestibular investigations including audiometry, discrimination test, caloric test, cervical vestibular evoked myogenic potential (c-VEMP), and ocular vestibular evoked myogenic potential (o-VEMP). RESULTS The difference between lesioned and non-lesioned ear was significant for all audiovestibular outcomes. The mean caloric deficit was 74%. No tumor sided o-VEMPs were elicited. Caloric deficit correlated with hearing loss measured with pure tone average and discrimination score. c-VEMP deficit was significantly associated with severe hearing loss and larger tumors. CONCLUSION The presence of VS leads to a significant deterioration of audiovestibular function in all objective measures. Caloric test and o-VEMPS are sensitive though unspecific measures of VSs. Increasing tumor size is not directly associated with hearing loss and only somewhat to vestibular deficit. However, audiovestibular findings are correlated.
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Affiliation(s)
- Niels West
- Department of Otorhinolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Martin Nue Møller
- Department of Otorhinolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Søren Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- University of Copenhagen, School of Health and Medical Sciences, Copenhagen, Denmark
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Herrera M, García Berrocal JR, García Arumí A, Lavilla MJ, Plaza G. Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:290-300. [PMID: 30093087 DOI: 10.1016/j.otorri.2018.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden, unexplained unilateral hearing loss. OBJECTIVES To update the Spanish Consensus on the diagnosis, treatment and follow-up of ISSNHL. MATERIAL AND METHODS After a systematic review of the literature from 1966 to March 2018, on MESH terms «(acute or sudden) hearing loss or deafness», a third update was performed, including 1508 relevant papers. RESULTS Regarding diagnosis, 11ISSNHL is clinically suspected, the following diagnostic tests are mandatory: otoscopy, acumetry, tonal audiometry, speech audiometry, and tympanometry, to discount conductive causes. After clinical diagnosis has been established, and before treatment is started, a full analysis should be performed. An MRI should then be requested, ideally performed during the first 15 days after diagnosis, to discount specific causes and to help to understand the physiopathological mechanisms in each case. Although treatment is very controversial, due to its effect on quality of life after ISSNHL and the few rare adverse effects associated with short-term steroid treatment, this consensus recommends that all patients should be treated with steroids, orally and/or intratympanically, depending on each patient. In the event of failure of systemic steroids, intratympanic rescue is also recommended. Follow-up should be at day 7, and after 12 months. CONCLUSION By consensus, results after treatment should be reported as absolute decibels recovered in pure tonal audiometry and as improvement in speech audiometry.
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Affiliation(s)
- Mayte Herrera
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España.
| | - José Ramón García Berrocal
- Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, España
| | - Ana García Arumí
- Servicio de Otorrinolaringología, Hospital Vall d'Hebron, Universidad Autónoma, Barcelona, España
| | - María José Lavilla
- Servicio de Otorrinolaringología, Hospital Clínico, Universidad de Zaragoza, España
| | - Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
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Tufatulin GS, Boboshko MY, Artyushkin SA. [Asymmetric sensorineural hearing impairment in the adult population]. Vestn Otorinolaringol 2018; 83:20-24. [PMID: 29953049 DOI: 10.17116/otorino201883320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The relevance of the problem of a sensorineural hearing loss (ASNL) arises from the necessity of the special approaches to the diagnostics of this condition, the complications accompanying this pathology, and the difficulties encountered in the implementation of the methods designed for hearing rehabilitation of such patients. The objective of the present study was to estimate the prevalence of ASHL among the adult population. The sensorineural impairment of hearing was diagnosed in a total of 2456 (72%) examined patients presenting with hearing loss. To determine the presence of asymmetry of sensorineural hearing loss, we employed three counting techniques allowing (1) to calculate the difference between the average hearing thresholds at four frequencies within the range from 0.5 to 4 kHz (the difference was found to be 15 dB or more in 17% of the patients), (2) to calculate the difference between the degrees of hearing loss in the right and left ears (the difference was documented in 47% of the patients), (3) to calculate the difference between the hearing thresholds at least at a single frequency within the range from 0.125 to 8 kHz (he difference was found to be 15 dB or more in 71% of the patients). When using the third method to characterize asymmetry of hearing impairment, it was identified in most patients (53%) at one or two frequencies. Moreover, there was a large number of the patients (13%) with asymmetry apparent over the entire frequency range. A high degree of threshold asymmetry (in excess of 40 dB) was more often noted in the mid-frequency range. In the majority of the patients, the asymmetry manifested itself as the different degree of bilateral sensorineural hearing impairment (51%) or unilateral sensorineural hearing loss with the normal hearing ability preserved in the contralateral ear (35%). The results of the present study give evidence of the necessity of developing a reliable method for the identification of clinically significant ACNL.
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Affiliation(s)
- G Sh Tufatulin
- Department of Otorhinolaryngology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of the Russian Federation, Saint-Petersburg, Russia, 191015
| | - M Yu Boboshko
- Department of Otorhinolaryngology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of the Russian Federation, Saint-Petersburg, Russia, 191015; Laboratory of Hearing and Speech, Academician I.P Pavlov, First Saint-Petersburg, State Medical University, Ministry of Health of the Russian Federation, Saint-Petersburg, Russia, 197022
| | - S A Artyushkin
- Department of Otorhinolaryngology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of the Russian Federation, Saint-Petersburg, Russia, 191015
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Sweeney AD, Carlson ML, Shepard NT, McCracken DJ, Vivas EX, Neff BA, Olson JJ. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Otologic and Audiologic Screening for Patients With Vestibular Schwannomas. Neurosurgery 2017; 82:E29-E31. [DOI: 10.1093/neuros/nyx509] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/02/2017] [Indexed: 11/12/2022] Open
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Kessler MM, Moussa M, Bykowski J, Kirsch CF, Aulino JM, Berger KL, Choudhri AF, Fife TD, Germano IM, Kendi AT, Kim JH, Luttrull MD, Nunez D, Shah LM, Sharma A, Shetty VS, Symko SC, Cornelius RS. ACR Appropriateness Criteria ® Tinnitus. J Am Coll Radiol 2017; 14:S584-S591. [DOI: 10.1016/j.jacr.2017.08.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
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Scholte M, Hentschel M, Kunst H, Steens S, Rovers M, Grutters J. Potential savings in the diagnosis of vestibular schwannoma. Clin Otolaryngol 2017; 43:285-290. [DOI: 10.1111/coa.12973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2017] [Indexed: 11/27/2022]
Affiliation(s)
- M. Scholte
- Department of Operating Rooms; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - M.A. Hentschel
- Department of Otolaryngology; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - H.P. Kunst
- Department of Otolaryngology; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - S.C.A. Steens
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - M.M. Rovers
- Department of Operating Rooms; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Health Evidence; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - J.P.C. Grutters
- Department of Operating Rooms; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Health Evidence; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
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Hentschel M, Scholte M, Steens S, Kunst H, Rovers M. 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. Clin Otolaryngol 2016; 42:815-823. [DOI: 10.1111/coa.12788] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2016] [Indexed: 11/27/2022]
Affiliation(s)
- M. Hentschel
- Department of Otolaryngology; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - M. Scholte
- Department of Operating Rooms; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - S. Steens
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - H. Kunst
- Department of Otolaryngology; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - M. Rovers
- Department of Operating Rooms; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Health Evidence; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
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Gimsing S, Nielsen MG. Noise-Induced Hearing Loss: Prevention is Possible. HEALTH SCOPE 2016. [DOI: 10.17795/jhealthscope-32741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Call me--mobile telephone blues. The Journal of Laryngology & Otology 2014; 128:393. [PMID: 24871789 DOI: 10.1017/s0022215114001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hougaard D, Norgaard A, Pedersen T, Bibby BM, Ovesen T. Is a redefinition of the growth criteria of vestibular schwannomas needed? Am J Otolaryngol 2014; 35:192-7. [PMID: 24439315 DOI: 10.1016/j.amjoto.2013.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 08/04/2013] [Accepted: 08/06/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE The natural history of vestibular schwannomas is poorly understood. Knowledge of growth rate and growth pattern is essential because the treatment strategy is based upon these. The purpose of this study was to determine the inter- and intraobserver variability in measuring VS size. MATERIALS AND METHODS Two consultant neuroradiologists independently made three linear measurements (d1, d2, d3) using digital MRI scans. MRI scans from 72 patients diagnosed between 2002 and 2010 with VS were obtained. These patients had a total of 223 MRI scans. d1 (medio-lateral diameter) was made perpendicular to d2. d2 was made parallel to the posterior border of the petrous ridge, and d3 was a measure of the cranio-caudal height of the tumor. RESULTS Limits of Agreement ranges are larger for interobserver reliability compared to intraobserver reliability. Measurement error for all diameters (except d1, intraobserver) is greater than 2mm. d1 measurements had the least variability and d3 measurements the highest variability, both for intra and interobserver measurements. CONCLUSIONS The optimal method of estimating VS size needs further investigation, and measurements need to be standardized and clearly defined. d3 seems to be the most difficult diameter to measure reliably. Interobserver measurement error for all diameters is greater than 2mm. The current VS growth criterion of more than 1-2mm, used to triage patients to surgery, lies within this error range, and thus is problematic as a guide for clinical practice. We therefore suggest that the growth criterion for VS be redefined.
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Affiliation(s)
- Dan Hougaard
- ENT Department, Aarhus University Hospital, Denmark.
| | - Anne Norgaard
- Department of Neuroradiology, Aarhus University Hospital, Denmark
| | - Thue Pedersen
- Department of Neuroradiology, Aarhus University Hospital, Denmark
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Roosli C, Linthicum FH, Cureoglu S, Merchant SN. Dysfunction of the cochlea contributing to hearing loss in acoustic neuromas: an underappreciated entity. Otol Neurotol 2012; 33:473-80. [PMID: 22377650 DOI: 10.1097/mao.0b013e318248ee02] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Hearing loss is a common symptom in patients with cochleovestibular schwannoma. Clinical and histologic observations have suggested that the hearing loss may be caused by both retrocochlear and cochlear mechanisms. Our goal was to perform a detailed assessment of cochlear pathology in patients with vestibular schwannoma (VS). STUDY DESIGN Retrospective analysis of temporal bone histopathology. SETTING Multi-center study. MATERIAL Temporal bones from 32 patients with unilateral, sporadic VS within the internal auditory canal. MAIN OUTCOME MEASURES Sections through the cochleae on the VS side and opposite (control) ear were evaluated for loss of inner and outer hair cells, atrophy of the stria vascularis, loss of cochlear neurons, and presence of endolymphatic hydrops and precipitate within the endolymph or perilymph. Observed pathologies were correlated to nerve of origin, VS volume, and distance of VS from the cochlea. Hearing thresholds also were assessed. RESULTS VS caused significantly more inner and outer hair cell loss, cochlear neuronal loss, precipitate in endolymph and perilymph, and decreased pure tone average, when compared with the opposite ear. Tumor size, distance from the cochlea, and nerve of origin did not correlate with structural changes in the cochlea or the hearing threshold. CONCLUSION There is significant degeneration of cochlear structures in ears with VS. Cochlear dysfunction may be an important contributor to the hearing loss caused by VS and can explain certain clinically observed phenomena in patients with VS.
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Affiliation(s)
- Christof Roosli
- Massachusetts Eye and Ear and Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Cheng TC, Wareing MJ. Three-Year Ear, Nose, and Throat Cross-sectional Analysis of Audiometric Protocols for Magnetic Resonance Imaging Screening of Acoustic Tumors. Otolaryngol Head Neck Surg 2011; 146:438-47. [DOI: 10.1177/0194599811427384] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. (1) Evaluate audiometric protocols and recommend protocols with best sensitivity and specificity for magnetic resonance imaging (MRI) screening of acoustic tumors; (2) determine clinical risks (false negative) of missing acoustic tumors and potential wastes in screening (false positive) nonacoustic tumors or radiologically “normal” cases; and (3) identify the decibel difference and range of frequencies compared by the best-performing protocols. Study Design. Cross-sectional study with chart review. Setting. Ear, nose, and throat (ENT); audiology; and radiology departments in a tertiary-care hospital. Subjects and Methods. Three-year cohort (2006-2009) of 1751 ENT patients underwent MRI screening and pure-tone audiometry indicating sensorineural hearing loss. Audiometric protocols were ranked by highest sensitivity to acoustic tumors, specificity A to nonacoustic tumors, and specificity B to “radiologically normal” cases. Results. No audiometric protocols achieved 100% sensitivity or specificity rates. Only 2 protocols achieved ≥90% sensitivity: the AMCLASS-A-Urben protocol (93.16%) and the Mangham protocol (91.58%). Eleven of 15 protocols for specificity A and 12 of 15 protocols for specificity B achieved ≥50%. Clinical risks ranged from 6.84% to 18.95%, whereas potential wastes ranged from 33.56% to 68.37% for specificity A and 31.76% to 66.86% for specificity B. Interaural difference parameters indicating highest mean sensitivity were on the order of ≥10 dB, ≥15 dB, and ≥20 dB. For frequency comparison parameters, “2 or more adjacent frequency” and “single-frequency” comparison indicated higher mean sensitivity than the “averaged multifrequency” comparison. Mean specificity showed an opposite pattern. Conclusions. 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.
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Acoustic neuroma risk in relation to mobile telephone use: results of the INTERPHONE international case-control study. Cancer Epidemiol 2011; 35:453-64. [PMID: 21862434 DOI: 10.1016/j.canep.2011.05.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 05/09/2011] [Accepted: 05/10/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND The rapid increase in mobile telephone use has generated concern about possible health risks of radiofrequency electromagnetic fields from these devices. METHODS A case-control study of 1105 patients with newly diagnosed acoustic neuroma (vestibular schwannoma) and 2145 controls was conducted in 13 countries using a common protocol. Past mobile phone use was assessed by personal interview. In the primary analysis, exposure time was censored at one year before the reference date (date of diagnosis for cases and date of diagnosis of the matched case for controls); analyses censoring exposure at five years before the reference date were also done to allow for a possible longer latent period. RESULTS The odds ratio (OR) of acoustic neuroma with ever having been a regular mobile phone user was 0.85 (95% confidence interval 0.69-1.04). The OR for ≥10 years after first regular mobile phone use was 0.76 (0.52-1.11). There was no trend of increasing ORs with increasing cumulative call time or cumulative number of calls, with the lowest OR (0.48 (0.30-0.78)) observed in the 9th decile of cumulative call time. In the 10th decile (≥1640 h) of cumulative call time, the OR was 1.32 (0.88-1.97); there were, however, implausible values of reported use in those with ≥1640 h of accumulated mobile phone use. With censoring at 5 years before the reference date the OR for ≥10 years after first regular mobile phone use was 0.83 (0.58-1.19) and for ≥1640 h of cumulative call time it was 2.79 (1.51-5.16), but again with no trend in the lower nine deciles and with the lowest OR in the 9th decile. In general, ORs were not greater in subjects who reported usual phone use on the same side of the head as their tumour than in those who reported it on the opposite side, but it was greater in those in the 10th decile of cumulative hours of use. CONCLUSIONS There was no increase in risk of acoustic neuroma with ever regular use of a mobile phone or for users who began regular use 10 years or more before the reference date. Elevated odds ratios observed at the highest level of cumulative call time could be due to chance, reporting bias or a causal effect. As acoustic neuroma is usually a slowly growing tumour, the interval between introduction of mobile phones and occurrence of the tumour might have been too short to observe an effect, if there is one.
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Schüz J, Steding-Jessen M, Hansen S, Stangerup SE, Cayé-Thomasen P, Poulsen AH, Olsen JH, Johansen C. Long-term mobile phone use and the risk of vestibular schwannoma: a Danish nationwide cohort study. Am J Epidemiol 2011; 174:416-22. [PMID: 21712479 DOI: 10.1093/aje/kwr112] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Vestibular schwannomas grow in the region within the brain where most of the energy by radiofrequency electromagnetic fields from using mobile phones is absorbed. The authors used 2 Danish nationwide cohort studies, one a study of all adult Danes subscribing for a mobile phone in 1995 or earlier and one on sociodemographic factors and cancer risk, and followed subjects included in both cohorts for occurrence of vestibular schwannoma up to 2006 inclusively. In this study including 2.9 million subjects, a long-term mobile phone subscription of ≥11 years was not related to an increased vestibular schwannoma risk in men (relative risk estimate = 0.87, 95% confidence interval: 0.52, 1.46), and no vestibular schwannoma cases among long-term subscribers occurred in women versus 1.6 expected. Vestibular schwannomas did not occur more often on the right side of the head, although the majority of Danes reported holding their mobile phone to the right ear. Vestibular schwannomas in long-term male subscribers were not of larger size than expected. Overall, no evidence was found that mobile phone use is related to the risk of vestibular schwannoma. Because of the usually slow growth of vestibular schwannoma and possible diagnostic delay, further surveillance is indicated.
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Affiliation(s)
- Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France.
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