Celis-Aguilar Erika, Obeso-Pereda Alejandra, Castro-Bórquez Karla M, Dehesa-Lopez Edgar, Vega-Alarcon Alfredo, Coutinho-De Toledo Heloisa
Department of Otolaryngology, Head and Neck Surgery, Universidad Autonoma de Sinaloa, Culiacan, MEX.
Department of Internal Medicine, Universidad Autonoma de Sinaloa, Culiacan, MEX.
Cureus. 2022 Jan 22;14(1):e21492. doi: 10.7759/cureus.21492. eCollection 2022 Jan.
Introduction Asymmetric sensorineural hearing loss is the main early symptom of retrocochlear lesions, hence its importance in screening for vestibular schwannomas. Currently, there is no consensus regarding its definition. The objective was to identify the audiometric pattern that would serve as a predictor for vestibular schwannoma in patients with asymmetric hearing loss. Materials and methods A cross-sectional study was conducted that included patients with asymmetric hearing loss attending a secondary care center and a tertiary care center. Clinical, audiometric and imaging (MRI with gadolinium) variables were collected. Asymmetric hearing loss was defined as a difference of 15 dB in one or more frequencies between both ears. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of different audiometric patterns were analyzed. Results A total of 107 patients were studied and divided into two groups: group 1 without vestibular schwannoma (n=98); and group 2 with vestibular schwannoma (n=9). No significant difference in demographic characteristics or audiometric patterns was found in patients with and without vestibular schwannoma. The audiometric pattern with the best sensitivity as a screening test was a difference >20 dB in the 4,000 Hz frequency, with a sensitivity of 77.78%, specificity of 30.61%, PPV of 8.33%, NPV of 93.75% and accuracy of 34.50%. Conclusion The audiometric pattern with the best results was a difference >20 dB in the 4,000 Hz frequency range; however, patients with asymmetric hearing loss could not be differentiated from patients with retrocochlear lesions based only on audiometry. Asymmetrical hearing loss must be studied with MRI.
引言 不对称性感音神经性听力损失是蜗后病变的主要早期症状，因此在筛查前庭神经鞘瘤方面具有重要意义。目前，关于其定义尚无共识。目的是确定可作为不对称性听力损失患者前庭神经鞘瘤预测指标的听力图模式。材料与方法 进行了一项横断面研究，纳入了在二级护理中心和三级护理中心就诊的不对称性听力损失患者。收集了临床、听力图和影像学（钆增强磁共振成像）变量。不对称性听力损失定义为双耳在一个或多个频率上相差15 dB。分析了不同听力图模式的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。结果 共研究了107例患者，分为两组：第1组无前庭神经鞘瘤（n = 98）；第2组有前庭神经鞘瘤（n = 9）。在前庭神经鞘瘤患者与无前庭神经鞘瘤患者之间，未发现人口统计学特征或听力图模式有显著差异。作为筛查试验，敏感性最佳的听力图模式是4000 Hz频率处相差>20 dB，敏感性为77.78%，特异性为30.61%，PPV为8.33%，NPV为93.75%，准确性为34.50%。结论 结果最佳的听力图模式是4000 Hz频率范围内相差>20 dB；然而，仅根据听力测定无法区分不对称性听力损失患者与蜗后病变患者。必须通过磁共振成像研究不对称性听力损失。
