Abstract
IntroductionAsymmetric 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 methodsA 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.ResultsA 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%.ConclusionThe 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.
Highlights
Asymmetric sensorineural hearing loss is the main early symptom of retrocochlear lesions, its importance in screening for vestibular schwannomas
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%, positive predictive value (PPV) of 8.33%, negative predictive value (NPV) of 93.75% and accuracy of 34.50%
Summary
A cross-sectional study was conducted that included patients with asymmetric hearing loss attending a secondary care center and a tertiary care center. 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. Consecutive patients were included from March 2009 to December 2010 at a tertiary care center and April 2016 to August 2018 at a secondary care center in a single otolaryngology clinic. The inclusion criteria were patients who attended the otorhinolaryngology service of a secondary care center and a tertiary care center with a diagnosis of asymmetric hearing loss by audiometry, defined as a difference of 15 dB in one or more frequencies between ears. After a diagnosis of asymmetric hearing loss, MRI was indicated.
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