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Development of a diagnostic model to identify patients at high risk for cerebellopontine angle lesions
Mayke Hentschel1, Maroeska Rovers2,3, Stefan Steens4
1Department of Otolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Philips van Leydenlaan 15, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. mayke.hentschel@radboudumc.nl.
Purpose:
To develop a diagnostic model to identify patients at high risk of a CPA lesion.
Methods:
A consecutive cohort of patients with AAD referred by a general practitioner, who underwent their first MRI examination of the CPA between 2005 and 2015 was included. Demographics, symptoms, findings during physical examination, and pure-tone audiometry were used as potential predictors. The presence of a CPA lesion was used as outcome.
Results:
We analyzed data of 2,214 patients, detecting 73 CPA lesions in 69 (3.1%) patients. The final model contained eleven variables, namely gender [male] [OR 1.055 (95% CI 0.885-1.905)], sudden onset of hearing loss [OR 0.768 (95% CI 0.318-0.992)], gradual onset of hearing loss [OR 1.069 (95% CI 0.500-1.450)], unilateral tinnitus [OR 0.682 (95% CI 0.374-0.999)], complaints of unilateral aural fullness [OR 1.006 (95% CI 0.783-2.155)], instability [OR 1.006 (95% CI 0.580-2.121)], headache [OR 0.959 (95% CI 0.059-1.090)], facial numbness [OR 2.746 (95% CI 0.548-11.085)], facial nerve dysfunction during physical examination [OR 1.024 (95% CI 0.280-3.702)], and asymmetry in BC at 1 kHz [OR 1.013 (95% CI 1.000-1.027)] and 4 kHz [OR 1.008 (95% CI 1.000-1.026)].
Conclusion:
The proposed diagnostic model is a first step in selecting patients with a high risk of a CPA lesion among those with AAD. It needs to be externally validated prior to its implementation in clinical practice.
