Moffat D A, Baguley D M, Beynon G J, Da Cruz M
Department of Otoneurological and Skull Base Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
Am J Otol. 1998 Jan;19(1):82-7.
This study aimed to quantify the atypical presentations of patients with vestibular schwannoma by applying the audiologic criteria for the treatment of patients to the Cambridge series of such tumors to show that clinical acumen is necessary for the effective screening of these tumors.
This study was a retrospective case review of 473 patients with vestibular schwannoma.
The surgery was conducted at the Department of Otoneurological and Skull Base Surgery, University Hospital, Cambridge, a tertiary referral center.
A total of 473 patients with a unilateral sporadic vestibular schwannoma were studied.
Measured were the principal presenting symptoms and the criteria for audiologic management.
Of this series of patients, 89.3% had a principal presenting symptom that was typical of vestibular schwannoma (hearing loss: progressive or sudden, imbalance or tinnitus) and 10.7% had an atypical principal presenting symptom. This group of patients had significantly larger tumors (Mann-Whitney U test; tied p value = 0.0002), shorter length of history (tied p value < 0.0001), and better preserved hearing (tied p value < 0.001) than the typical otologic presentation group. These clinical correlates are related to tumor morphology, and it is hypothesized that the site of the neurilemmal-glial junction (medial or lateral) has an effect here. If the U.S. criteria for the treatment of a patient by an audiologist are applied to this series of patients, then 7 patients (1.5%) would not have had the diagnosis of vestibular schwannoma. If the U.K. criteria are applied, this number of missed tumors is 17 (3.6%). The addition of unilateral tinnitus as an indicator of the need for otologic investigation reduced the number of patients who might be missed to 2 (0.42%) for the U.S. cases and 5 (1.1%) for the U.K. cases.
Of patients with vestibular schwannoma, 10.7% have an atypical principal presenting symptom, and this group of patients has significantly larger tumors than those patients who present typically. This finding is of particular relevance to the entry point of such cases to the healthcare system. A number of patients with vestibular schwannoma appear to pass the criteria for treatment by an audiologist without reference to an otologic opinion. These patients may not be investigated from an early stage with potential implications for increased morbidity.
本研究旨在通过将听力学治疗标准应用于剑桥系列前庭神经鞘瘤患者，量化该疾病患者的非典型表现，以表明有效筛查这些肿瘤需要临床敏锐度。
本研究是对473例前庭神经鞘瘤患者的回顾性病例分析。
手术在剑桥大学医院耳神经科和颅底外科进行，该医院是一家三级转诊中心。
共研究了473例单侧散发性前庭神经鞘瘤患者。
测量主要症状表现及听力学治疗标准。
在这组患者中，89.3%的患者主要症状表现典型（听力损失：渐进性或突发性、平衡失调或耳鸣），10.7%的患者主要症状表现不典型。与典型耳科表现组相比，该组患者肿瘤明显更大（曼-惠特尼U检验；并列p值=0.0002），病史更短（并列p值<0.0001），听力保留更好（并列p值<0.001）。这些临床关联与肿瘤形态有关，据推测神经膜-神经胶质连接部位（内侧或外侧）在此处有影响。如果将美国听力学家的患者治疗标准应用于这组患者，那么7例患者（1.5%）不会被诊断为前庭神经鞘瘤。如果应用英国标准，漏诊肿瘤的数量为17例（3.6%）。将单侧耳鸣作为耳科检查必要性的指标，美国病例中可能漏诊的患者数量减少到2例（0.42%），英国病例中减少到5例（1.1%）。
在前庭神经鞘瘤患者中，10.7%的患者主要症状表现不典型，且该组患者的肿瘤明显大于典型表现的患者。这一发现与这类病例进入医疗系统的切入点特别相关。一些前庭神经鞘瘤患者似乎在未参考耳科意见的情况下就通过了听力学家的治疗标准。这些患者可能无法从早期就接受检查，这可能会增加发病风险。
