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Otology/Neurotology

(092) Clinical Predictors of Positive MRI in Vestibular Schwannomas

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Risha Sheni, BS

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

    • Author(s)

  • Kareem Al-Mulki, MD

    Resident
    Department of Otolarynology - Head and Neck Surgery, Montefiore Medical Center
    Bronx, New York, United States

  • Tyler Bergeron, BS

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

  • TS

    Thomas Scharfenberger, BS

    Albert Einstein College of Medicine, USA

    • Senior Author(s)

  • HM

    Howard Moskowitz, MD, PhD

    Associate Professor
    Department of Otolarynology - Head and Neck Surgery, Montefiore Medical Center
    Bronx, New York, United States

Disclosure(s):
Risha Sheni, BS: No relevant relationships to disclose.
Kareem Al-Mulki, MD: No relevant relationships to disclose.
Tyler Bergeron, BS: No relevant relationships to disclose.
Howard Moskowitz, MD, PhD: No relevant relationships to disclose.


Introduction: Gadolinium-enhanced MRI has become the gold standard for detecting vestibular schwannomas, but can be difficult to tolerate, has low yield, remains costly, and is generally time-consuming. Various screening protocols based on audiometric findings exist, but none are universally followed. These protocols also do not account for symptoms or clinical signs which may be predictors of positive MRI. We sought to explore clinical history, symptoms, and physical exam findings as predictors of positive MRI which may guide imaging of patients with asymmetric sensorineural hearing loss (ASNHL) in the workup of vestibular schwannomas.

Methods: This is a retrospective cohort study at an urban community-based center of patients who underwent audiometric testing and internal auditory canal MRI from November 2015 to October 2022. Patients were separated into positive MRI and negative groups, based on the presence of a vestibular schwannoma. Variables of interest included history of diabetes, history of chemotherapy, aspirin use, SSRI use, time since symptom onset, hemoglobin A1C, and presence of vertigo, tinnitus, ear pain, and facial nerve weakness.

Results: Of the 179 patients included in this preliminary analysis, 13 (7.3%) had positive MRI and 166 (92.7%) had negative MRI findings for vestibular schwannoma. A greater proportion of MRI positive compared to MRI negative patients reported tinnitus (76.9% vs. 60%). A greater proportion of MRI negative compared to MRI positive patients had diabetes (27.1% vs. 15.4%) and were taking aspirin (25.9% vs. 15.4%). Ear pain was reported in 13.8% of the MRI negative group and none in the positive group. On univariate analysis, these differences were not statistically significant.

Conclusions: This study assessed multiple variables that warrant further investigation as imaging practices in working up ASNHL for vestibular schwannoma become uniform and evidence-based. Larger studies, including one of the estimated 2,000 patients at our institution who meet inclusion criteria in this time frame, are warranted to elucidate clinical predictors for vestibular schwannomas found on MRI.