[The value of clinical examination methods in diagnosis of acoustic neuroma].
The diagnostic value of routine clinical tests for predicting the presence of an acoustic neuroma (AN) was assessed retrospectively in a group of 391 patients having magnetic resonance imaging (MRI) scans because of a suspected retrolabyrinthine lesion. An AN was found by MRI only in 9% of these patients. The positive predictive value of unilateral sensorineural hearing loss in a pure-tone audiogram (PTA) and unilaterally impaired caloric response was 9% and 12%, respectively. In contrast, AN was found in 36% of patients with pathological brainstem evoked response audiometry (BE-RA). A normal PTA or normal caloric response did not exclude the presence of AN (specificity 90% and 71%, respectively). A normal BERA was found in less than 5% of the patients with AN. According to these results, the following guidelines should be followed for the diagnosis of AN: (1) patients with a high suspicion for AN from history, PTA and caloric responses should be sent directly for MRI; (2) patients with low suspicion for AN from screening tests should have BERA performed to exclude a retrolabyrinthine lesion.
Scherler
M
M
Klinik und Poliklinik für Otorhinolaryngologie, Hals- und Gesichtschirurgie, Universitätsspital Zürich.
Böhmer
A
A
D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold / Q000502:physiology; D001933:Brain Stem / Q000503:physiopathology; D002150:Caloric Tests; D003937:Diagnosis, Differential; D004292:Dominance, Cerebral / Q000502:physiology; D004584:Electronystagmography; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D006313:Hearing Loss, Central / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D009464:Neuroma, Acoustic / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011930:Reaction Time / Q000502:physiology; D012680:Sensitivity and Specificity