J Neurol Surg B Skull Base 2016; 77 - FP-05-01
DOI: 10.1055/s-0036-1592456

The Diagnostic Accuracy of Nonimaging Screening Protocols for Vestibular Schwannoma in Patients with Asymmetrical Hearing Loss and/or Unilateral Audiovestibular Dysfunction: A Diagnostic Systematic Review and Meta-Analysis

Mayke Hentschel 1, Mirre Scholte 2, Stefan Steens 3, Maroeska Rovers 2, Dirk Kunst 1
  • 1Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
  • 2Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands
  • 3Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

Objective: The aim of this diagnostic review and meta-analysis was to assess the diagnostic accuracy of different non-imaging screening protocols in patients at risk of vestibular schwannoma.

Methods: We systematically searched MEDLINE, Embase, and the Cochrane Library as from inception up to January 3, 2016. We included studies that compared non-imaging screening protocols to MRI as gold reference standard. Methodological quality was assessed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Data necessary to complete 2×2 tables were obtained and patient, study, and screening characteristics were extracted. We calculated sensitivity and specificity of all tests and obtained pooled estimates using a bivariate random effects model.

Results: We analyzed 12 studies (4,549 patients) of poor to moderate quality according to the quality assessment. Most studies tested diagnostic accuracy of multiple screening protocols. Five pure-tone audiometry protocols were studied by multiple authors; pooled estimates for sensitivity ranged from 89% [95% CI: 80–99] to 94% [72–99] and specificity from 39% [23–58] to 58% [49–65]. Due to heterogeneity we were unable to pool other tests. In five studies testing auditory brainstem response, sensitivity values ranged from 37% [23–52] to 100% [40–100] and specificity from 57 to 96% [87–100]. Two studies investigated pure-tone audiometry shapes. Presenting symptoms, electronystagmography, caloric irrigation and hyperventilation test were assessed by one study each. All reported low diagnostic accuracy.

Conclusion: All identified studies had a high risk of bias and none of the currently available non-imaging screening protocols appear to be accurate in detecting vestibular schwannomas. Future studies should focus on finding an effective diagnostic screening protocol.