Stratifying Risk and Size of Acoustic Neuroma: When Should Magnetic Resonance Imaging Be Recommended

Sunday, September 29, 2024

8:48 AM – 8:54 AM EDT

Location: MBCC, 231

Disclosure(s):

Brandon D. Kamrava, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Matthew D. Wiefels, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Michael E. Hoffer, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Asymmetric sensorineural hearing loss (ASNHL) lacks universally accepted criteria, leading to diagnostic and management challenges. Acoustic neuromas, which commonly present with ASNHL, are common, with lifetime prevalence now estimated to exceed 1 per 500 persons. MRI, the gold standard for evaluation, can be costly and have low diagnostic yield; this study aims to improve guidelines and risk stratification for patients with ASNHL.

Methods: A retrospective case-control study was conducted using electronic medical records from the University of Miami hospital system (2010-2020). Subjects included adults with ASNHL who underwent MRI evaluation. Data on demographics, audiometric measures, and MRI findings were analyzed. Logistic regression models were used to identify associations between clinical data and significant MRI findings.

Results: Out of 277 patients, 57 (20.6%) had significant MRI findings. Utilizing multivariate analysis, the following screening criteria was developed: asymmetry of 90dB in bilateral thresholds AND asymmetry of at least 20dB at 2000Hz. The odds ratio of a positive MRI for those meeting the criterion is 2.743 (95% CI: 1, 7.52; p = 0.0049). Accepted screening criteria, when applied to the study’s dataset demonstrated an accuracy of 21% as compared to an accuracy of 75% with the experimental criterion. The inclusion of necessitating patients to meet both criteria of asymmetry at 2000Hz and overall asymmetry has significant correlation with increased mean maximum tumor size (1.07 vs 1.54 cm, p < 0.275).

Conclusions: As compared to prior screening models for ASNHL, this study presents an incredibly more accurate model for risk stratification, improving MRI recommendation guidelines. The proposed criteria could reduce unnecessary MRIs and related economic burden while ensuring patients with significant findings receive appropriate evaluation.

Presenting Author(s)

Brandon D. Kamrava, MD

Otolaryngology - Head and Neck Surgery Resident
University of Miami Health System / Jackson Memorial Hospital
Miami, Florida, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Matthew D. Wiefels, BS

Medical Student
University of Miami Miller School of Medicine
Miami, FL, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
MS

Martin Slade, PhD

Yale University School of Medicine, United States

Disclosure information not submitted.
MH

Michael E. Hoffer, MD

Neurotologist
University of Miami Health System / Jackson Memorial Hospital
Miami, FL, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Bjorn S. Herman, MD

Assistant Professor
University of Miami Department of Otolaryngology
Palm Beach Gardens, FL, United States

Disclosure information not submitted.