Abstract
ObjectiveTo compare international diagnostic and management strategies for vestibular schwannoma (VS).MethodsA web-based questionnaire was sent to 130 otolaryngologists, mainly identified through the European Skull Base Society. It contained questions on general information including guideline usage as well as questions on diagnosis (focussing on selection of patients for MRI) and management of VS, including case scenarios. Descriptive statistics were reported.ResultsThirty-six otolaryngologists working in 11 different countries completed the questionnaire (response rate: 28%). Guidelines for diagnosis and management of VS are used by 44% and 42% of respondents, respectively. In the diagnostic strategy for VS, different types and combinations of audiovestibular function tests are used when deciding whether a patient should undergo an MRI. Respondents apply 18 different definitions of asymmetrical hearing loss. Variation was also apparent from reported considerations on management of VS. Most respondents (84%) prefer a wait-and-scan strategy in case of a small intrameatal VS (Koos 1). Variety in management strategies increases for patients with a medium to large sized VS (Koos 2, 3 and 4). The details of each management strategy (wait-and-scan, microsurgery, stereotactic radiosurgery and fractionated radiotherapy) also differ among respondents.ConclusionsA large variation in diagnostic and management strategies for VS was identified between respondents. More evidence and/or consensus seem warranted to reduce uncertainties for patients, and differences in outcome and costs that might result from the variety of strategies currently being applied.
Highlights
Patients with a vestibular schwannoma (VS) usually present with symptoms of sensorineural hearing loss, tinnitus, vertigo and/or disequilibrium
To obtain information regarding the current diagnostic and management strategies for VS, an online questionnaire was sent to 102 otolaryngologists working in 15 different countries, that were registered in the European Skull Base Society database
We investigated the definition of asymmetrical hearing loss that respondents apply when referring patients for Magnetic resonance imaging (MRI)
Summary
Patients with a vestibular schwannoma (VS) usually present with symptoms of (asymmetrical) sensorineural hearing loss, tinnitus, vertigo and/or disequilibrium. Magnetic resonance imaging (MRI) is considered the gold standard to diagnose VS and is performed whenever there is a high suspicion of VS in patients with aforementioned symptoms [1]. It is, a challenge to determine which patients should undergo MRI, the reported yield of diagnostic MRIs being approximately 3% [2, 3]. In the third section different management strategies for VS were addressed, including the proportion of patients being assigned to each strategy, variables used when considering management strategies, and their conduct It included several case scenarios describing VSs of increasing size (see Fig. 1). All analyses were performed using IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA)
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