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Review
. 2022 Nov 14;12(11):2776.
doi: 10.3390/diagnostics12112776.

The Diagnostic Accuracy of Pure-Tone Audiometry Screening Protocols for Vestibular Schwannoma in Patients with Asymmetrical Hearing Loss-A Systematic Review and Meta-Analysis

Liliana Gheorghe  1   2 , Dragos Negru  1   2 , Mihail Dan Cobzeanu  1   2 , Octavian Dragos Palade  1   2 , Eosefina Gina Botnariu  2   3 , Bogdan Mihail Cobzeanu  1   4 , Maria-Luiza Cobzeanu  1   2
Affiliations
Review

The Diagnostic Accuracy of Pure-Tone Audiometry Screening Protocols for Vestibular Schwannoma in Patients with Asymmetrical Hearing Loss-A Systematic Review and Meta-Analysis

Liliana Gheorghe et al. Diagnostics (Basel). .

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.

Keywords: acoustic neuroma; magnetic resonance imaging; pure-tone audiometry; vestibular schwannoma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of search and selection of studies. * markup of data source.
Figure 2
Figure 2
Meta-analysis of Mangham protocol. (a) Forrest plot of pooled sensitivity and specificity [8,21,22,23,24,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
Figure 3
Figure 3
Meta-analysis of Sunderland protocol. (a) Forrest plot of pooled sensitivity and specificity [8,10,22,24,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
Figure 4
Figure 4
Meta-analysis of Department of Health protocol. (a) Forrest plot of pooled sensitivity and specificity [8,10,22,23,24,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
Figure 5
Figure 5
Meta-analysis of Schlauch and Levine protocol. (a) Forrest plot of pooled sensitivity and specificity [8,21,23,24,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
Figure 6
Figure 6
Meta-analysis of Sheppard protocol. (a) Forrest plot of pooled sensitivity and specificity [8,21,23,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
Figure 7
Figure 7
Meta-analysis of Seattle protocol. (a) Forrest plot of pooled sensitivity and specificity [8,10,22,24,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
Figure 8
Figure 8
Meta-analysis of Oxford protocol. (a) Forrest plot of pooled sensitivity and specificity [8,10,22,24,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
Figure 9
Figure 9
Meta-analysis of Obholzer protocol. (a) Forrest plot of pooled sensitivity and specificity [8,21,23,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
Figure 10
Figure 10
Meta-analysis of Amclass protocol. (a) Forrest plot of pooled sensitivity and specificity [8,22,23,24,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
Figure 11
Figure 11
Meta-analysis of AAO protocol. (a) Forrest plot of pooled sensitivity and specificity [8,10,22,23,24,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
Figure 12
Figure 12
Meta-analysis of Nashville protocol. (a) Forrest plot of pooled sensitivity and specificity [8,10,22,24,25]; (b) Hierarchical summary receiver operating characteristic (HSROC) curve; (c) Likelihood ratio scattergram; (d) Fagan nomogram.
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