title: ABR in the diagnosis of vestibular schwannomas: a meta-analysis.
abstract: OBJECTIVE
  The aim of this study is to rigorously evaluate the role of auditory brainstem response (ABR) testing in the diagnosis of vestibular schwannomas (VS).
  
  
  METHODS
  Searches were conducted in multiple online databases, supplemented by hand searches. From the studies chosen for final inclusion, relevant data were extracted and meta-analysis of pooled data was performed.
  
  
  RESULTS
  623 studies were identified from which 43 met inclusion criteria for analysis (1978 to 2009) including 3314 patients. Pooled sensitivity for ABR detection of vestibular schwannomas was 93.4% (95% CI 92.6-94.3, P=0.0000). For tumors less than 1cm (8 studies, 176 patients) sensitivity was 85.8% (95% CI 80.6-90.1, P=0.0116). For tumors greater than 1cm (6 studies, 251 patients) pooled sensitivity was 95.6% (95% CI 93.1-98.2, P=0.0660). Sensitivity of ABR to detect extracanalicular tumors was higher than for intracanalicular tumors, though pooled data were not statistically valid. Pooled specificity (8 studies, 2432 patients) was 82.0% (95% CI 80.5-83.6, P=0.0000).
  
  
  CONCLUSIONS
  Although MRI remains the gold standard, emerging trends towards more conservative management coupled with limited financial resources may prompt many clinicians to review the role of ABR testing in screening for retrocochlear pathology. In light of the high sensitivity and specificity of ABR testing for VS, we strongly urge its reconsideration as a useful diagnostic tool for patients with clinically suspected VS.
authors: Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA.
authors: Paul D
authors: PD
authors: Koors
authors: Leroy R
authors: LR
authors: Thacker
authors: Daniel H
authors: DH
authors: Coelho
mesh_terms: D016057:Evoked Potentials, Auditory, Brain Stem; D006801:Humans; D009464:Neuroma, Acoustic / Q000175:diagnosis*; D012680:Sensitivity and Specificity