Presenting Complaint and Diagnostic Yield of MRIs for Vestibular Schwannomas

To ascertain the diagnostic yield of MRIs to diagnose vestibular schwannoma based on the patient's presenting symptoms and age.

A retrospective cohort study at a single centre. All MRIs ordered by otolaryngologists from 01/01/2022 to 31/12/2023 for the purpose of diagnosing a vestibular schwannoma were included. Data on presenting symptoms, audiogram results, demographics and management outcomes were extracted from clinical records.

1814 MRIs were included. The overall diagnostic yield of vestibular schwannomas was 1.65% (30 cases). Mild asymmetrical sensorineural hearing loss alone (defined as < 15 dB difference between ears at two consecutive frequencies) was not associated with vestibular schwannoma; no patients with this finding were diagnosed (p = 0.025). On multivariate analysis, vertigo (odds ratio [OR] 4.03, p < 0.001) and severe asymmetrical sensorineural hearing loss (OR 5.26, p = 0.002) were independently associated with a diagnosis. Unilateral tinnitus (OR 2.10, p = 0.062), sudden onset asymmetrical hearing loss (OR 0.57, p = 0.46), mild asymmetrical hearing loss (OR 1.03, p = 0.98), or age (OR 0.74, p = 0.48) were not significantly associated with a vestibular schwannoma. Incidental findings were common (23%) and most patients (80%) were managed conservatively with serial MRIs. There was no correlation between age and likelihood of diagnosis.

The diagnostic yield of MRIs for vestibular schwannomas is low. Patients with isolated mild asymmetrical hearing loss alone may not warrant further investigation. Presenting with unilateral tinnitus was a poor discriminator for a diagnosis of vestibular schwannomas. However, patients with unexplained vertigo should be considered for an MRI. Further research is needed to refine current guidelines.