Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines Update for the Role of Audiologic Screening in the Diagnosis and Management of Patients With Vestibular Schwannomas

BACKGROUND: Vestibular schwannoma (VS) represents a benign tumor of the vestibulocochlear nerve that presents with otologic dysfunction. Although MRI remains the most common technique for imaging diagnosis of VS, there are no unifying guidelines to suggest when a practitioner should obtain a screening MRI for new otologic complaints to rule out VS. OBJECTIVE: We aim to assess the diagnostic yield of MRI in the detection of VS in patients presenting with asymmetric sensorineural hearing loss (SNHL), unilateral tinnitus, and sudden SNHL. METHODS: The questions from the previously published guideline were updated to patient/intervention/comparison/outcome format. A comprehensive literature search from 1/1/2015 to 5/20/2022 was performed to answer preconceived research questions drafted by the joint tumor task force. A systematic review of the existing body of evidence was conducted based on predefined inclusion criteria to determine the diagnostic yield of MRI for the diagnosis of VS in patients presenting with (1) asymmetric SNHL, (2) unilateral tinnitus, and (3) sudden SNHL. RESULTS: Of the 704 articles initially reviewed, 14 individual publications incorporating 13 733 patients met inclusion criteria. When considering nonredundant data sets, the diagnostic yield of MRI for VS remains low in patients presenting with SNHL (1.68%), unilateral tinnitus (1.56%), and sudden SNHL (3.66%). CONCLUSION: This document serves as Congress of Neurologic Surgeon's most up to date and current recommendations on the audiometric screening of VS expanding on the previous 2018 version. Patients presenting with otologic complaints of asymmetric SNHL, tinnitus, or sudden SNHL have an estimated 1%-3% chance of a VS being the causative lesion. Current screening protocols have an approximate 15% rate of abnormal MRI leading to a diagnosis other than VS meaning that 85% of patients presenting with asymmetric SNHL, tinnitus, and sudden SNHL will have no structural cause on imaging studies.