A rapid scan of the literature

A rapid scan of the literature 26 March 2009 Screening for the early detection of acoustic neuroma in patients with asymmetric sensorineural hearing...
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A rapid scan of the literature

26 March 2009

Screening for the early detection of acoustic neuroma in patients with asymmetric sensorineural hearing loss: a rapid literature scan of MRI and other surveillance methods

Dan Paech Adele Weston

This report should be referenced as follows: Paech, D, and Weston, A. Screening for the early detection of acoustic neuroma in patients with asymmetric sensorineural hearing loss: a rapid literature scan of MRI and other surveillance methods HSAC Report 2009; 2(1). 2009 Health Services Assessment Collaboration (HSAC), University of Canterbury ISBN 978-0-9582973-5-6 (online) ISBN 978-0-9582973-6-3 (print) ISSN 1178-5748 (online) ISSN 1178-573X (print)

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Review Team This review was undertaken by the Health Services Assessment Collaboration (HSAC). HSAC is a collaboration of the Health Sciences Centre of the University of Canterbury, New Zealand and Health Technology Analysts, Sydney, Australia. This report was authored by Dan Paech who developed and undertook the literature search, extracted the data, and prepared the report, and Dr Adele Weston who provided guidance and reviewed the report. The current review was conducted under the auspices of a contract funded by the New Zealand Ministry of Health. This report was requested by Dr Sandy Dawson of New Zealand’s Ministry of Health. We thank Dr Dawson for assisting in developing the scope of the review and providing background material for the review.

Copyright Statement & Disclaimer This report is copyright. Apart from any use as permitted under the Copyright Act 1994, no part may be reproduced by any process without written permission from HSAC. Requests and inquiries concerning reproduction and rights should be directed to the Director, Health Services Assessment Collaboration, Health Sciences Centre, University of Canterbury, Private Bag 4800, Christchurch, New Zealand. HSAC takes great care to ensure the accuracy of the information in this report, but neither HSAC, the University of Canterbury, Health Technology Analysts Pty Ltd nor the Ministry of Health make any representations or warranties in respect of the accuracy or quality of the information, or accept responsibility for the accuracy, correctness, completeness or use of this report. The reader should always consult the original database from which each abstract is derived along with the original articles before making decisions based on a document or abstract. All responsibility for action based on any information in this report rests with the reader. This report is not intended to be used as personal health advice. People seeking individual medical advice should contact their physician or health professional. The views expressed in this report are those of HSAC and do not necessarily represent those of the University of Canterbury New Zealand, Health Technology Analysts Pty Ltd, Australia or the Ministry of Health.

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Contact Details Health Services Assessment Collaboration (HSAC) Health Sciences Centre University of Canterbury Private Bag 4800 Christchurch 8140 New Zealand Tel: +64 3 345 8147 Fax: +64 3 345 8191 Email: [email protected] Web Site: www.healthsac.net

Screening in ASNHL for acoustic neuroma

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Executive Summary Introduction This report provides a brief scan of the literature available on the role of magnetic resonance imaging (MRI) and comparative surveillance techniques in screening for the early detection of acoustic neuroma (AN) in patients with asymmetric sensorineural hearing loss (ASNHL). It was commissioned by the New Zealand Ministry of Health.

Methods A systematic method of literature searching and study selection was employed in the preparation of this report. The literature was searched using the bibliographic databases of EMBASE and Medline. The Cochrane Database of Systematic Reviews and numerous health technology assessment websites were also searched to help identify existing reviews or clinical practice guidelines. In addition, the bibliographies of key included papers were examined for relevant studies. It is important to note that as this was a brief scan of the evidence, and not a full systematic review, detailed quality appraisal, data extraction and interpretation of the identified literature was not performed. The review relies heavily upon material reported in each publication’s abstract.

Key results The search strategy identified a total of 451 citations, of which 289 were included for title/abstract review. After consideration of titles and abstracts using the study selection criteria, 53 citations were included in the review. Only the papers of the citations considered most relevant to the topic of interest were retrieved for more indepth description. There was also one systematic review identified which is due for publication in April 2009. All available details of this review are provided. The literature gathered in this report suggests that MRI is considered the ‘gold standard’ in detecting ANs in patients with ASNHL. Although auditory brainstem response (ABR) testing is also widely used, it has been shown to have insufficient sensitivity and specificity to be used as a sole screening test. There is particular concern around its ability to identify small sized tumours. Nonetheless, there appears to be significant variety in the way clinicians screen and manage patients presenting with ASNHL. This may be due to the fact that there are no universally accepted clinical practice guidelines, and because of the accessibility and cost issues of screening all patients with MRI. Whether or not MRI maintains its superiority once costs are taken into account has not been addressed in this report.

Conclusions The review concludes with suggested directions of action and potential research questions for this topic.

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Table of Contents Review Team ................................................................................................................. i Copyright Statement & Disclaimer ............................................................................. i Contact Details ............................................................................................................. ii Executive Summary ....................................................................................................iii Introduction ............................................................................................................... iii Methods ..................................................................................................................... iii Key results ................................................................................................................. iii Conclusions ............................................................................................................... iii Table of Contents ........................................................................................................ iv List of Tables ................................................................................................................ v Introduction .................................................................................................................. 1 Literature Search ......................................................................................................... 3 Results ........................................................................................................................... 7 Review of screening techniques ................................................................................. 7 Systematic review ...................................................................................................... 7 Prospective studies ..................................................................................................... 8 Retrospective studies ................................................................................................ 10 Reviews, patient management or clinical practice papers ....................................... 14 Cost based studies .................................................................................................... 17 Key publications....................................................................................................... 20 Published audiological screening protocols ............................................................. 24 Summary and Recommendations ............................................................................. 27 Conclusions .............................................................................................................. 27 References ................................................................................................................... 29 Appendix A: HTA websites searched ....................................................................... 35 Appendix B: Excluded studies annotated by reason for exclusion ....................... 37

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List of Tables Table 1 Table 2 Table 3 Table 4 Table 5 Table 6 Table 7 Table 8

Summary of the literature search .............................................................. 4 Criteria for inclusion/exclusion in review ................................................ 4 Prospective studies identified through the literature search ..................... 9 Summary of retrospective cohort studies ............................................... 11 Summary of publications classified as a review, patient management or clinical practice paper ............................................................................. 14 Summary of cost based studies ............................................................... 17 Results of MRI and ABR screening tests ............................................... 22 A description of published decision-support protocols for acoustic neuroma .................................................................................................. 25

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Introduction Hearing loss is the most prevalent sensory deficit reported by patients. In Australia, 10–20% of Australians have some hearing impairment and approximately 50% of those over 65 years of age are hearing impaired. Hearing loss can be conductive, sensorineural or mixed, with sensorineural occurring most frequently in adults (Angeli et al. 2005). Sensorineural hearing loss indicates defects in either the cochlea or in the neural transmission to the central nervous system. Asymmetric sensorineural hearing loss (ASNHL) is defined as binaural difference in conduction thresholds of >10 dB at two consecutive frequencies or >15 dB at one frequency (0.25–8.0 kHz) (Sabini and Sclafani 2000). One pathology which may present as ASNHL is acoustic neuroma (AN), also known as vestibular schwannoma. Acoustic neuroma is a benign tumour arising from the Schwann cells in the vestibular portion of the eighth cranial nerve. However, the majority of patients who present with ASNHL do not have AN, the reported incidence being approximately 2% of all patients with ASNHL (Urben et al. 1999). As a result, selecting patients with ASNHL for further investigation continues to pose challenges, given the disparity between the number of symptomatic patients, and the low incidence of AN as the underlying cause (Nouraei et al. 2007). When patients present with symptoms that may indicate an AN, magnetic resonance imaging (MRI) is often considered the diagnostic test of choice. However, there are some patients for whom MRI is inappropriate (e.g. patients with implanted electrical devices or a cerebral aneurysm clip), and increasingly there are cost and accessibility issues associated with MRI (Prasad and Cousins 2008). Contention also surrounds the most efficient MRI protocol to use in the investigation of suspected AN. Electrophysiological measurement of the auditory brainstem response (ABR) is another diagnostic technique which has been used to diagnose AN (National Institute of Health Research 2007). This report will gather the evidence on MRI, and the place of any other screening tests, in the early detection of AN. An extensive literature search was conducted as is described below. The aim of the literature search was to provide a rapid overview of the available evidence for screening ASNHL patients for AN, with a particular focus on MRI. The results of each identified study should be considered with the year of publication in mind, as significant advances in technology have occurred in AN diagnosis over the last 20 years.

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Literature Search A search of the EMBASE, Medline and Cochrane database as well as numerous HTA websites (Appendix A) was conducted to identify any published guidelines, systematic reviews or publications pertaining to the screening of patients with ASNHL for the identification of acoustic neuromas. The literature source, search terms, number of citations identified and date of the search is outlined in Table 1. Many of the citations identified through the search of the Cochrane library and HTA websites were duplicates already identified through the EMBASE/Medline search, or were completely irrelevant to the topic of interest, and were therefore excluded before downloading into the Reference Manager database.

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Summary of the literature search

Source

Search terms

Citations

Date

EMBASE.com (Includes EMBASE and Medline)

(('acoustic neuroma'/exp OR 'acoustic neuroma') OR 'vestibular schwannoma' OR ('neurinoma'/exp OR 'neurinoma')) AND ('asymmetric sensorineural hearing loss' OR 'asymmetric sensori-neural hearing loss' OR ('sensorineural hearing loss'/exp OR 'sensorineural hearing loss') OR 'sensori-neural hearing loss' OR 'asymmetrical sensorineural hearing loss' OR 'asymmetrical sensori-neural hearing loss' OR ('perception deafness'/exp OR 'perception deafness')) AND [english]/lim AND [humans]/lim

281

03/02/2009

Cochrane library

‘Sensorineural hearing loss’ OR ‘vestibular schwannoma’ OR ‘acoustic neuroma’

86

03/02/2009

CADTH

‘Sensorineural hearing loss’ OR ‘vestibular schwannoma’ OR ‘acoustic neuroma’

49

03/02/2009

EuroScan

‘Sensorineural hearing loss’ OR ‘vestibular schwannoma’ OR ‘acoustic neuroma’

20

03/02/2009

National guideline clearinghouse

‘Sensorineural hearing loss’ OR ‘vestibular schwannoma’ OR ‘acoustic neuroma’

7

03/02/2009

National Institute for Health Research

‘Sensorineural hearing loss’ OR ‘vestibular schwannoma’ OR ‘acoustic neuroma’

6

03/02/2009

NICE

‘Sensorineural hearing loss’ OR ‘vestibular schwannoma’ OR ‘acoustic neuroma’

2

03/02/2009

INAHTA

‘Sensorineural hearing loss’ OR ‘vestibular schwannoma’ OR ‘acoustic neuroma’

0

03/02/2009

MSAC

‘Sensorineural hearing loss’ OR ‘vestibular schwannoma’ OR ‘acoustic neuroma’

0

03/02/2009

ANZHSN

‘Sensorineural hearing loss’ OR ‘vestibular schwannoma’ OR ‘acoustic neuroma’

0

03/02/2009

AHRQ

‘Sensorineural hearing loss’ OR ‘vestibular schwannoma’ OR ‘acoustic neuroma’

0

03/02/2009

451

03/02/2009

Total

Abbreviations: AHRQ, Agency for Healthcare Research and Quality; ANZHSN, Australia and New Zealand Horizon Scanning Network; CADTH, Canadian Agency for Drugs and Technology in Health; INAHTA, International Network of Agencies for Health Technology Assessment; MSAC, medical Services Advisory Committee; NICE, National Institute for Clinical Excellence.

In addition, a general internet search was performed to identify any additional publications, clinical practice guidelines or systematic reviews. There were 289 citations downloaded into the reference manager database from the various sources described above. The titles and abstracts (where available) were reviewed using the inclusion and exclusion criteria outlined below in Table 2. Table 2

Criteria for inclusion/exclusion in review

Reason for exclusion

Number of citations excluded

Incorrect study type: case study (15 dB in the frequencies 500-4 kHz. The MRI showed a 18 x 16mm lesion in the right internal acoustic meatus displacing the cerebellum and pons. The authors suggest universal screening for AN is debatable due to the low pick up rate and high expense of MRI. They suggest applying a protocol to select patients for MRI is worth considering. Screening patients with sensorineural hearing loss for vestibular schwannoma using a Bayesian classifier (Nouraei et al. 2007) This study retrospectively examined records of 129 patients with a proven diagnosis of vestibular schwannoma based on MRI scans, and an equal number of patients in whom this diagnosis was suspected, but excluded on MRI. There were 130 males and 128 females and the average age at presentation was 53 ± 15 years (± sd; range 16–97 years). On direct questioning, 121 patients (46%) reported unilateral tinnitus and 79 (30%) episodic vertigo. There were significant overlaps in the degree of hearing threshold asymmetry between patients with and without a vestibular schwannoma across all frequencies. A Gaussian Process Ordinal Regression Classifier was used to predict the likelihood of a patient having or not having a vestibular schwannoma on

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21 the basis of clinical and audiological data. Variables used for analysis included pure tone thresholds at 250 Hz, 500 Hz, 1 kHz, 2 kHz, 4 kHz and 8 kHz at the time of presentation, as well as patient age and sex, and the presence or absence of unilateral tinnitus or episodic vertigo. The study proved it possible to pre-select sensitivity and specificity, with an area under the curve of 0.8025. At 95% sensitivity, the trained system had a specificity of 56%, 30% better than audiological protocols with closest sensitivities. Authors concluded that if applied prospectively, it could reduce the number of ‘normal’ MRI scans by as much as 30% without reducing detection sensitivity. Asymmetric sensorineural hearing loss evaluation with T2 FSE-MRI in a public hospital (Verret et al. 2006) The records of patients with ASNHL presenting in a country hospital who underwent MRI evaluation were examined. As part of the screening process, a GD-enhanced MRI scan sequence was obtained; however this also included a non-GD-enhanced FSE T2 sequence. A total of 146 patients were identified with patients ranging from 20–84 years with a mean age of 55 years. There were 56 male and 90 female patients. Of the 146 MRI scans performed, abnormalities were seen on 71 of them, the majority of which were inconsequential (e.g. sinonasal disease, gray/white matter changes, and previous cerebrovascular disease or intracranial procedures). However, none of the abnormalities were retrocochlear or explained the etiology of the audiological findings. The authors estimated that the cost of GD-enhanced MRI was US$1200, with a T2 FSE protocol costing about $415. For this study population, a saving of US$114 610 would have been realised if only a T2 FSE protocol had been used. The authors concluded that T2-weighted FSE can be economically beneficial for screening patients with ASNHL without other neurological findings in a public hospital population. Magnetic resonance imaging screening for vestibular schwannoma: analysis of published protocols (Obholzer and Harcourt 2004) This was a retrospective review of radiology reports from all MRIs of the internal auditory meatus, performed during the year 2000 at Charing Cross Hospital. The notes of all patients who had vestibular schwannoma and those of the last 100 ‘negative’ scans were requested. The presenting symptoms and pure tone audiograms were extracted and data were analysed comparing the sensitivity and specificity of differences in hearing loss at each specific frequency, at any two and any three frequencies, and utilising six published protocols. Thirty-six patients with vestibular schwannomas were included and 92 without, eight case notes were unavailable. Thirty two of the 36 presented with ASNHL, 19 of whom also had tinnitus. Four criteria had a sensitivity of > 95%; of these the highest specificity (49%) utilised an interaural difference at two adjacent frequencies of 15 dB in unilateral hearing loss and 20dB in bilateral asymmetric loss. The most sensitive criterion was a difference of 15 dB at any frequency (sensitivity 100% and specificity 29%). The optimal combination of sensitivity and specificity was achieved using a criterion of >15 dB difference at two adjacent frequencies if the mean threshold in the better ear was ≤30 dB, and 20 dB if greater than 30 dB. This produced 97% sensitivity and 49% specificity. The application of the best protocol would have reduced the number of MRI scans requested from 392 to 168, saving 224 patients’ scans.

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22 Magnetic resonance imaging for the evaluation of asymmetric sensorineural hearing loss (Cueva 2004) This was a multi-institutional, prospective, non-randomised comparison of ABR and MRI with gadolinium for the evaluation of patients with ASNHL (defined as ≥15 dB in 2 or more pure tone thresholds or an asymmetry of ≥15% on speech discrimination score). There were 312 patients (between the ages of 18 and 87 years) who completed the study. Patients prospectively underwent both ABR and MRI with the primary outcome being the presence or absence of retrocochlear pathology. The results of the two screening tests are shown below in Table 7. Table 7

Results of MRI and ABR screening tests MRI + Causative lesion

- Causative lesion

Total

Abnormal

22

73

95

Normal

9

208

217

Total

31

281

312

ABR

Thirty-one (9.94%) patients of the study population of 312 were found on MRI to have lesions causing their SNHL. Of the 31 patients with causative lesions on MRI there were 24 vestibular schwannomas. Twenty-two of the 31 patients had abnormal ABRs, whereas 9 patients (7 with small vestibular schwannomas) had normal ABRs. This gives an overall false-negative rate for ABR of 29%. The false-positive rate was found to be 77%. Sensitivity of ABR as a screening test was 71%, and specificity was 74%. The ABR positive predictive value was 23% and negative predictive value was 96%. ABR was been demonstrated to have low sensitivity and specificity in the evaluation of these patients and cannot be relied on as a screening test for patients with asymmetric SNHL. Keeping the use of MRI conditional on the results of ABR will annually result in missed or delayed diagnosis of causative lesions in 29 patients per 1,000 screened. The author recommends abandoning ABR as a screening test for asymmetric SNHL and adoption of a focused MRI protocol as the screening test of choice. Screening for vestibular schwannoma: current practice in New Zealand (Dawes 1999) This study reported the results of a questionnaire survey of New Zealand otolaryngologists. Sixty seven questionnaires were sent. Forty-two replies were received, three other replies indicated that the member had retired from clinical practice. The results indicated that 41 clinicians preferred MRI testing for screening for AN. However, only 29 had locally available imaging equipment. Twenty-four clinicians used MRI as their first screening test, 10 used ABR and then MRI, 7 used clinical judgement and other investigations and one used CT scanning only. The survey also indicated that many clinicians still use ABR and CT as a preliminary screen to select for MRI because of financial or local political reasons. The author believes New Zealand would be best served by a single set of vestibular schwannoma screening guidelines.

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23 MRI in the detection of acoustic neuromas- a suggested protocol for screening (Sheppard 1996) During the period September 1990 to September 1993, 920 requests for MRI imaging of the IAM or cerebellopontine angle were made within the Oxford region. A total of 892 scans were successfully carried out. The symptoms of ENT patients scanned from the Oxford Department of Otolaryngology included sudden and gradual sensorineural hearing loss, tinnitus, vertigo, otalgia. Facial numbness and facial palsy. The decision to scan was based on the presence of asymmetrical audiovestibular symptoms as outlined by Robson et al. (1993). Initially, all patients had sagittal and axial T, weighted interleaved images performed after the administration of gadolinium. The current scanning protocol involves only 3 mm interleaved fast spin echo T, weighted axial scans. Four millimetres T, weighted images with gadolinium-DTPA enhancement are used if there is diagnostic doubt. Of the total number of patients scanned (n = 892), an acoustic neuroma was detected in 38 (4.26%). Of these patients, 16 were men and 22 women. Of the 38, 18 were from non-Oxford clinics, 20 from oxford clinics. Those from the Oxford clinic all had a degree of ASNHL ranging from 15 dB to 92 dB between normal and abnormal ears. The study suggested a protocol for the selection of MRI which was: those patients up to 70 years of age presenting with unilateral audiovestibular symptoms in the absence of significant neurological symptoms or signs, with an average difference in hearing threshold of 15 dB between normal and symptomatic ears or unilateral tinnitus with normal hearing. A prospective study of ABR and MRI in the screening for vestibular schwannomas (Ruckenstein et al. 1996) This was a prospective study of 47 patients with ASNHL. Adult patients (18 years or older) with asymmetry in two or more pure-tone thresholds of ≥15 dB were included. The mean age of patients was 56 years with 19% older than 65 years. All patients underwent an ABR and enhanced MRI scan. ABRs were considered abnormal if they demonstrated asymmetric IT5 latencies (asymmetry >0.2ms), abnormal absolute wave V latencies, or absent or poor waveform morphology. All MRI scans were reviewed by a neuroradiologist for the presence or absence of retrocochlear disease. The authors obtained a sensitivity of 63%, specificity of 64%, positive predictive value of 26%, and negative predictive value of 89% for the ABR test. The 3 ANs missed were all less than 2 cm. The authors concluded that ABR testing was not an ideal screening test, cautioning, however, that a larger sample size would be required for confirmation of this assertion. Cost-effective initial screening for vestibular schwannoma: auditory brainstem response or magnetic resonance imaging? (Rupa et al. 2003) This study aimed to determine the cost-effectiveness of including ABR testing in a screening protocol for the diagnosis of AN in patients with asymmetric auditory symptoms at the Christian Medical College and Hospital, Vellore, India, where, commonly, patients with AN have tumours greater than 2 cm at the time of diagnosis. Ninety patients who presented to the ENT Department with asymmetric auditory symptoms of hearing loss and tinnitus were prospectively evaluated by pure tone audiometry, ABR testing, and gadolinium-enhanced MRI (GdMRI) of the temporal bone and brain. Of a total of 90 patients enrolled in the study, 56 were males and 34

Screening in ASNHL for acoustic neuroma

24 females (age range, 15 to 66 years). Of the 30 patients who were found to have retrocochlear pathology on ABR, 4 patients were diagnosed as having AN. The study indicated that the cost of GdMRI was approximately 15 times the cost of ABR. Thus, if all 90 patients had undergone GdMRI alone, the total cost of investigation would have been $18,000. If only the 48 patients who had either no response or evidence of retrocochlear pathology on ABR underwent GdMRI, the cost of screening would have been $9,600. Therefore, a protocol involving screening all patients with ABR and only subjecting those patients with no response or retrocochlear pathology on ABR to MRI would save up to $7,200 in total. Because 6 patients with AN were identified, the saving in cost per patient diagnosed correctly was $1,200. This would be the approximate total cost of having the tumour surgically excised at this hospital. The authors concluded that the financial burden of identifying patients with AN could be considerably reduced with a screening protocol including ABR. Asymmetric sensorineural hearing loss in a community-based population (Urben et al. 1999) This was a 5-year retrospective study that examined patients older than 17 years with ASNHL (defined as an interaural difference in pure-tone thresholds ≥10 dB at 2 frequencies or ≥15 dB at 1 frequency. The study also conducted a cost analysis for diagnosing AN. All patients’ medical records and audiograms were reviewed for demographic, historic, and audiologic data and results from ABRs and radiologic studies. Of all the audiograms reviewed, 193 (21%) met the audiological criteria for ASNHL. Patients with ASNHL were a median age of 51 years, with 66% male and 34% female. Among the 193 patients who had diagnostic studies, 4 were found to have ANs, for a prevalence of 2.1%. ABR tests were performed in 179 patients (55%), and 92% (164 of 179) were normal. Patients with abnormal or inconclusive ABR and patients with severe SNHL were evaluated with radiologic studies (46 patients). Of the 34 who had an MRI, 30 were normal and four were abnormal. All 19 CT scans were judged as normal. To assess the cost of diagnosis per AN, the study determined the charges for diagnostic studies. Charges may differ from patient costs. Because audiograms were used in the inclusion criteria for the study, the charge for audiograms was excluded. The charges for diagnostic studies were multiplied by the number of studies performed, and a charge of $166,955 was incurred in identifying 4 patients with AN and ASNHL. The charge of diagnosis per AN was more than $41,000. The authors suggest a cost containment protocol for screening AN.

Published audiological screening protocols Acoustic neuromas produce patterns of audiovestibular symptoms and in particular ASNHL, which tends to be different between patients with and without an AN. This difference has been used to develop a number of different decision-support protocols for clinicians, to assist in risk-stratifying patients, with those at higher risk being referred for an MRI. A brief description of published audiological screening protocols for AN is shown in Table 8.

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A description of published decision-support protocols for acoustic neuroma

Name

Clinical criteria

Asymmetry of thresholds

Seattle (Mangham 1991)

Nil

≥15 dB between the average of 1-8 KHz

Charing cross (Obholzer et al. 2004)

Nil

≥15 dB in any two neighbouring frequencies if the average hearing threshold of the better ear ≤30 dB≥20 dB in any two neighbouring frequencies if the average hearing threshold of the better ear >30 dB

Nashville (Welling et al. 1990)

Nil

≥15 dB at any frequency between 0.5 and 4 KHz

Oxford (Sheppard et al. 1996)

Unilateral tinnitus, age < 70 years

≥15 dB between the average of 0.5 to 8 KHz

UK Department of Health (2002)

Vertigo

≥ 20 dB at any frequency between 0.5 and 4 KHz

Sunderland (Dawes et al. 1998)

Unilateral tinnitus or Meniere’s disease symptoms

≥ 20 dB between two neighbouring frequencies

Source: Nouraei et al. (2007), Table 1 page 251.

None of these protocols are universally accepted for screening AN in patients with ASNHL.

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Screening in ASNHL for acoustic neuroma

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Summary and Recommendations Conclusions This preliminary report presents the evidence for the early detection of AN using MRI or other comparative diagnostic techniques in patients with ASNHL, albeit without critical appraisal. It appears there is a significant clinical argument to support the routine use of MRI. The test has been reported to have high sensitivity and specificity, higher than that of the ABR test. However, the widespread use of MRI in this patient population is problematic due to the high cost per diagnosis of AN (attributed to the high cost of MRI and low incidence rate of AN in ASNHL presenting patients), and issues surrounding accessibility to MRI equipment. Most papers suggest a protocol or guidelines be implemented to help select patients for MRI screening. However this approach accepts that there is a trade-off between cost efficiency, and the risk of missing some tumours. Points to consider As mentioned previously there is a systematic review due for publication by the NIHR in April 2009 titled: ‘The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: systematic review of clinical and cost effectiveness, and natural history’ Alternatively a full systematic review could be considered on the use of MRI in screening patients with ASNHL for the early detection of AN.

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30 Daniels RL, Shelton C, and Harnsberger HR. (1998) Ultra high resolution nonenhanced fast spin echo magnetic resonance imaging: Cost-effective screening for acoustic neuroma in patients with sudden sensorineural hearing loss. American Journal of Otolaryngology - Head and Neck Medicine and Surgery 119:364-369. Dawes PJD. (1999) Screening for vestibular schwannoma: Current practice in New Zealand. Australian Journal of Otolaryngology 3:307-310. Dawes PJD and Jeannon JP. (1998) Audit of regional screening guidelines for vestibular schwannoma. The Journal of Laryngology and Otology 112:860-864. Dornhoffer JL, Helms J, and Hoehmann DH. (1994) Presentation and diagnosis of small acoustic tumors. American Journal of Otolaryngology– Head & Neck Surgery 111:232-235. El Kashlan HK, Eisenmann D, and Kileny PR. (2000) Auditory brain stem response in small acoustic neuromas. Ear and Hearing 21:257-262. Fortnum H, Nikolopoulos T, O'Neill C, Taylor R, Baguley D, Lenthall R, et al. (2007) The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: systematic review of clinical- and cost- effectiveness, and natural history. National Institute of Health Research. Hashimoto S, Kawase T, Furukawa K, and Takasaka T. (1991) Strategy for the diagnosis of small acoustic neuromas. Acta Oto-Laryngologica, Supplement 481:567569. Isaacson JE and Vora NM. (2003) Differential diagnosis and treatment of hearing loss. American Family Physician 68:1125-1132. Kanzaki J, Ogawa K, Ogawa S, Yamamoto M, Ikeda S, and Uchi T. (1991) Audiological findings in acoustic neuroma. Acta Oto-Laryngologica, Supplement 487:125-132. Kanzaki J, Ogawa K, Tsuchihashi N, Yamamoto M, Ogawa S, and Uchi T. (1991) Diagnostic procedure for acoustic neuroma. Acta Oto-Laryngologica, Supplement 487:114-119. Kanzaki J. (1986) Present state of early neurotological diagnosis of acoustic neuroma. Journal for Oto-rhino-laryngology and its Related Specialities 48:193-198. Kubo T, Sakashita T, Kusuki M, Kyunai K, Ueno K, Hikawa C, Wada T, and Nakai Y. (2000) Evaluation of radiological examination for sensorineural hearing loss. Acta Oto-Laryngologica, Supplement -:34-38. Levy RA and Arts HA. (1996) Predicting neuroradiologic outcome in patients referred for audiovestibular dysfunction. American Journal of Neuroradiology 17:1717-1724.

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31 Mahrous AK and Kalepu R. (2008) Positive findings on MRI in patients with asymmetrical SNHL. European Archives of Otolaryngology-Rhino-Laryngology 265:1471-1475. Manfre L, Angileri T, Ferrara S, Accardi M, Raineri R, and Lagalla R. (1997) The role of magnetic resonance imaging in central hearing deficits: Beyond the acoustic schwannoma. Rivista di Neuroradiologia 10:409-416. Mangham CA and Welling DB. (1992) Acoustic neuroma: Cost-effective approach [1]. Archives of Otolaryngology– Head & Neck Surgery 106:315-316. Mangham CA. (1991) Hearing threshold difference between ears and the risk of acoustic tumour. Archives of Otolaryngology– Head & Neck Surgery 105:814-817. Monsell EM and Rock JP. (1990) Sensorineural hearing loss and the diagnosis of acoustic neuroma. Henry Ford Hospital Medical Journal 38:9-12. Montaguti M, Bergonzoni C, Zanetti MA, and Rinaldi Ceroni A. (2007) Comparative evaluation of ABR abnormalities in patients with and without neurinoma of VIII cranial nerve. Acta Oto-Laryngologica 27:68-72. Morley S and Beale TJ. (2007) Imaging of deafness and tinnitus. Imaging 19:55-70. Murphy MR and Selesnick SH. (2002) Cost-effective diagnosis of acoustic neuromas: a philosophical, macroeconomic, and technological decision (Brief record). Archives of Otolaryngology– Head & Neck Surgery 127:253-259. Myrseth E, Pederson PH, Moller P, and Lund-Johansen M. (2007) Treatment of vestibular schwannomas. Why, when and how? Acta Neurochirurgica 49:647-660. National Institute of Health Research. (2009) The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: systematic review of clinical and cost effectiveness, and natural history. UK Department of Health. Nouraei S, Huys Q, Chatrath P, Powles J, and Harcourt J. (2007) Screening patients with sensorineural hearing loss for vestibular schwannoma using a Bayesian classifier. Clinical Otalaryngology 32:248-254. Obholzer RJ and Harcourt JP. (2004) Magnetic resonance imaging screening for vestibular schwannoma: analysis of published protocols. The Journal of Laryngology and Otology. 118:329-332. Prasad J and Cousins VC. (2004) Asymmetrical hearing loss. Australian Family Physician 37(4):312-320. Ravi K, V and Wells SC. (1996) A cost effective screening protocol for vestibular schwannoma in the late 90s (Brief record). The Journal of Laryngology and Otology. 110:1129-1132.

Screening in ASNHL for acoustic neuroma

32 Robinette MS, Bauch CD, Olsen WO, and Cevette MJ. (2000) Auditory brainstem response and magnetic resonance imaging for acoustic neuromas: costs by prevalence (Brief record). Archives of Otolaryngology. Head and Neck Surgery 126:963-966. Robson AK, Leighton SE, Anslow P, and Milford CA. (1993) MRI as a single screening procedure for acoustic neuroma: a cost effective protocol. Journal of the Royal Society of Medicine 86:455-457. Ruckenstein MJ, Cueva RA, Morrison DH, and Press G. (1996) A prospective study of ABR and MRI in the screening for vestibular schwannomas. American Journal of Otology 17:317-320. Rupa V, Job A, George M, and Rajshekhar V. (2003) Cost-effective initial screening for vestibular schwannoma: auditory brainstem response or magnetic resonance imaging? Otolaryngology– Head & Neck Surgery 128:823-828. Sabini P and Sclafani AP. (2000) Efficacy of serologic testing in asymmetrical sensorinerual hearing loss. Otolaryngology– Head & Neck Surgery 122:469-476. Saunders JE, Luxford WM, Devgan KK, and Fetterman BL. (1995) Sudden hearing loss in acoustic neuroma patients. Otolaryngology– Head and Neck Surgery 113:2331. Schmidt RJ, Sataloff RT, Newman J, Spiegel JR, and Myers DL. (2001) The sensitivity of auditory brainstem response testing for the diagnosis of acoustic neuromas. Archives of Otolaryngology– Head & Neck Surgery 127:19-22. Sheppard IJ, Milford CA, and Anslow P. (1995) MRI in the detection of acoustic neuromas- a suggested protocol for screening. Clinical Otolaryngology & Allied Sciences 21:301-304. Smith IM, Turnbull LW, Sellar RJ, Murray JAM, and Best JJK. (1990) A modified screening protocol for the diagnosis of acoustic neuromas. Clinical Otolaryngology and Allied Sciences 15:167-171. Soulie D, Cordoliani YS, Vignaud J, and Cosnard G. (1997) MR imaging of acoustic neuroma with high resolution fast spin echo T2-weighted sequence. European Journal of Radiology 24:61-65. Spoelhof GD. (1995) When to suspect an acoustic neuroma. American Family Physician 52:1768-1774. Stack JP, Ramsden RT, Antoun NM, Lye RH, Isherwood I, and Jenkins JP. (1988) Magnetic resonance imaging of acoustic neuromas: the role of gadolinium-DTPA. The British Journal of Radiology 61:800-805. Swan IRC. (1989) Diagnostic vetting of individuals with asymmetric sensorineural hearing impairments. Journal of Laryngology and Otology 103:823-826.

Screening in ASNHL for acoustic neuroma

33 Swartz JD. (2004) Lesions of the cerebellopontine angle and internal auditory canal: diagnosis and differential diagnosis. Seminars in Ultrasound, CT, and MRI 25:332352. Telian SA, Kileny PR, Niparko JK, Kemink JL, and Graham MD. (1989) Normal auditory brainstem response in patients with acoustic neuroma. The Laryngoscope 99:10-14. Thomsen J and Tos M. (1993) Management of acoustic neuromas. Annales d'OtoLaryngologie et de Chirurgie Cervico-Faciale 110:179-191. UK Department of Health. (2002) Clinical effectiveness guidelines: acoustic neuroma (vestibular schwannoma). UK Department of Health. Urben SL, Benninger MS, and Gibbens ND. (1999) Asymmetrical sensorineural hearing loss in a community-based population. Otolaryngology– Head & Neck Surgery 120:809-814. Verret DJ, Adelson R, and Defatta R. (2006) Asymmetric sensorineural hearing loss evaluation with T2 FSE-MRI in a public hospital. Acta Oto-Laryngologica 126:705707. Vossough A. (2003) Imaging evaluation of sensorineural hearing loss. Applied Radiology 32:6-14. Wareing MJ, Baguley D, and Moffat DA. (2002) Investigations for vestibular schwannoma. CME Bulletin Otorhinolaryngology Head and Neck Surgery 6:12-15. Welling DB, Glassock ME, Woods CI, et al. (1990) Acoustic neuroma: a costeffective approach. Otolaryngology– Head & Neck Surgery 103:364-370. Wright A and Bradford R. (1995) Management of acoustic neuroma. British Medical Journal 311:1141-1144. Zealley IA, Cooper RC, Clifford KM, Campbell RS, Potterton AJ, Zammit-Maempal I, Baudouin CJ, and Coulthard AJ. (2000) MRI screening for acoustic neuroma: a comparison of fast spin echo and contrast enhanced imaging in 1233 patients. The British Journal of Radiology 73:247.

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34

Screening in ASNHL for acoustic neuroma

35

Appendix A: HTA websites searched HTA and systematic review databases to be searched for this project are:  Health Technology Assessment Database (via the Cochrane Library): http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME  INAHTA website database: http://www.inahta.org/Search2/?pub=1 Note: Can search database and gain access to individual member websites. Individual HTA groups:  MSAC: http://www.msac.gov.au/  ANZHSN: http://www.horizonscanning.gov.au/  NZHTA: http://nzhta.chmeds.ac.nz/  NICE: http://www.nice.org.uk/  AHRQ/USPSTF: http://www.ahrq.gov/  CADTH: http://www.cadth.ca/

Screening in ASNHL for acoustic neuroma

36

Screening in ASNHL for acoustic neuroma

37

Appendix B: Excluded studies annotated by reason for exclusion Farrell III JT. (1983) Radiographic evaluation of acoustic neuromas: Comparison of high-resolution computed tomography and polytomography. Journal of the American Osteopathic Association 83:61-66. Reason for exclusion: Incorrect study type Adelman S. (1983) Identification of acoustic neuroma in noise-exposed workers. Scandinavian Audiology 12:247-250. Reason for exclusion: Incorrect study type Flood LM and Brightwell AP. (1984) Cochlear deafness in the presentation of a large acoustic neuroma. Journal of Laryngology and Otology 98:87-92. Reason for exclusion: Incorrect study type Terry RM. (1985) An unusual presentation of acoustic neuroma. Journal of Laryngology and Otology 99:593-595. Reason for exclusion: Incorrect study type David M and Trehub SE. (1989) Perspectives on deafened adults. American Annals of the Deaf 134:200204. Reason for exclusion: Incorrect study type

acoustic schwannoma: Post-operative hearing in the contralateral ear. Journal of Laryngology and Otology 105:769-771. Reason for exclusion: Incorrect study type Moon HH, Jabour BA, Andrews JC, Canalis RF, Chen FH, Anzai Y, Becker DP, Lufkin RB, and Hanafee WN. (1991) Nonneoplastic enhancing lesions mimicking intracanalicular acoustic neuroma on gadoliniumenhanced MR images. Radiology 179:795-796. Reason for exclusion: Incorrect study type House H, Sheehy J, De la Cruz A, House J, Nelson R, Luxford W, Shelton C, and Linthicum J. (1991) Docs' discussion at HEC. American Journal of Otology 12:147-149. Reason for exclusion: Incorrect study type Vellutini EAS, Cruz OLM, Velasco OP, Miniti A, and Almeida GM. (1991) Reversible hearing loss from cerebellopontine angle tumors. Neurosurgery 28:310-313. Reason for exclusion: Incorrect study type

(1990) Docs' Discussion at OMG. American Journal of Otology 11:141143. Reason for exclusion: Incorrect study type

Berenholz LP, Eriksen C, and Hirsh FA. (1992) Recovery from repeated sudden hearing loss with corticosteroid use in the presence of an acoustic neuroma. Annals of Otology, Rhinology and Laryngology 101:827831. Reason for exclusion: Incorrect study type

Farrell ML, Harries MLL, Baguley DM, and Moffat DA. (1991) Bilateral

Quester R, Menzel J, and Thumfart W. (1993) Radical removal of a large

Screening in ASNHL for acoustic neuroma

38 glossopharyngeal neurinoma with preservation of cranial nerve functions. Ear, Nose and Throat Journal 72:600611. Reason for exclusion: Incorrect study type Ghobashy A and Van Loveren H. (1993) Acoustic schwannoma presenting as acute posterior fossa hematoma: Case report and review of the literature. Skull Base Surgery 3:136-140. Reason for exclusion: Incorrect study type Kingdom TT, Lalwani AK, Pitts LH, Chandler WF, and Salcman M. (1993) Isolated metastatic melanoma of the cerebellopontine angle: Case report. Neurosurgery 33:142-144. Reason for exclusion: Incorrect study type Van Leeuwen JPPM, Cremers CWRJ, Thijssen HOM, and Meyer HE. (1993) Unchanged unilateral hearing loss and ipsilateral growth of an acoustic neuroma from 1 to 4 cm. Journal of Laryngology and Otology 107:230232. Reason for exclusion: Incorrect study type Shelton C. (1993) Doc's Discussion at HEC. American Journal of Otology 14:199-202. Reason for exclusion: Incorrect study type O'Donoghue GM. (1993) Acoustic neuroma: triumph and disaster. British Journal of Hospital Medicine 49:8587. Reason for exclusion: Incorrect study type Levine RA, Bu-Saba N, and Brown MC. (1993) Laser-Doppler measurements and

electrocochleography during ischemia of the guinea pig cochlea: Implications for hearing preservation in acoustic neuroma surgery. Annals of Otology, Rhinology and Laryngology 102:127136. Reason for exclusion: Incorrect study type Kawaguchi T, Tanaka R, Kameyama S, and Yamazaki H. (1994) Full recovery from deafness after removal of a large acoustic neurinoma associated with neurofibromatosis 2: Case report. Surgical Neurology 42:326-329. Reason for exclusion: Incorrect study type Downie AC, Howlett DC, Koefman RJ, Banerjee AK, and Tonge KA. (1994) Case report: prolonged contrast enhancement of the inner ear on magnetic resonance imaging in Ramsay Hunt syndrome. British Journal of Radiology 67:819-821. Reason for exclusion: Incorrect study type Linstrom CJ, Krajewski MJ, Shapiro AL, and Caruana S. (1994) Outer table graft in middle fossa surgery. Otolaryngology - Head and Neck Surgery 111:70-75. Reason for exclusion: Incorrect study type Sakakibara A, Aoyagi M, and Koike Y. (1994) Acoustic neuroma presented as repeated hearing loss. Acta OtoLaryngologica, Supplement 511:77-80. Reason for exclusion: Incorrect study type Donnelly MJ, Daly CA, and Briggs RJS. (1994) MR imaging features of an intracochlear acoustic schwannoma. Journal of Laryngology and Otology 108:1111-1114.

Screening in ASNHL for acoustic neuroma

39 Reason for exclusion: Incorrect study type Sells JP and Hurley RM. (1994) Acoustic neuroma in an adolescent without neurofibromatosis: case study. Journal of the American Academy of Audiology 5:349-354. Reason for exclusion: Incorrect study type Schneider ML, Walker GB, and Dormer KJ. (1995) Effects of magnetic resonance imaging on implantable permanent magnets. American Journal of Otology 16:687-689. Reason for exclusion: Incorrect study type Wall MP and Block R. (1995) Annual meeting of the American Laryngological, Rhinological, and Otological Society. Archives of Otolaryngology - Head and Neck Surgery 121:1065-1066. Reason for exclusion: Incorrect study type Saeed SR, Woolford TJ, Ramsden RT, and Lye RH. (1995) Magnetic resonance imaging: A cost-effective first line investigation in the detection of vestibular schwannomas. British Journal of Neurosurgery 9:497-503. Reason for exclusion: Incorrect study type Minor LB. (1995) Neuro-otology: Hearing. Current Opinion in Neurology 8:89-94. Reason for exclusion: Incorrect study type Peh WC and Yuen AP. (1995) Clinics in diagnostic imaging. Singapore medical journal 36:433-436. Reason for exclusion: Incorrect study type Judkins RF and Rubin AM. (1995)

Sudden hearing loss and unstable angina pectoris. Ear, Nose and Throat Journal 74:96-99. Reason for exclusion: Incorrect study type Gaffney RJ and McShane DP. (1996) Bilateral acoustic neurofibromatosis camouflaged by corticosteroid treatment of sudden sensorineural hearing loss. Leukemia 10:151-152. Reason for exclusion: Incorrect study type Nishizawa S, Yokoyama T, Hinokuma K, and Uemura K. (1997) Unilateral sensori-neural hearing disturbance caused by intramedullary cerebellar tumors. Neurologia MedicoChirurgica 37:701-707. Reason for exclusion: Incorrect study type Ishikawa K, Yasui N, Monoh K, Tada H, Mineura K, Sasajima H, and Togawa K. (1997) Unilateral acoustic neuroma in childhood. Auris Nasus Larynx 24:99-104. Reason for exclusion: Incorrect study type Fitzgerald DC, Mark AS, and Shelton C. (1999) Cost-effective screening for acoustic neuroma [1] (multiple letters). Otolaryngology - Head and Neck Surgery 121:846. Reason for exclusion: Incorrect study type Shamboul KM and Grundfast K. (1999) Hearing loss in neurofibromatosis type 1: Report of two cases. East African Medical Journal 76:117-119. Reason for exclusion: Incorrect study type Selesnick SH, Deora M, Drotman MB, and Heier LA. (1999) Incidental discovery of acoustic neuromas.

Screening in ASNHL for acoustic neuroma

40 Otolaryngology - Head and Neck Surgery 120:815-818. Reason for exclusion: Incorrect study type Tripathy LN, Forster DMC, and Timperley WR. (1999) Adult primitive neuroectodermal tumour. A case report and review of the literature. British Journal of Neurosurgery 13:90-92. Reason for exclusion: Incorrect study type Michaels L, Lee K, Manuja SL, and Soucek SO. (1999) Family with lowgrade neuroendocrine carcinoma of salivary glands, severe sensorineural hearing loss, and enamel hypoplasia. American Journal of Medical Genetics 83:183-186. Reason for exclusion: Incorrect study type Hasegawa T, Kobayashi T, Kida Y, Tanaka T, Yoshida K, and Osuka K. (1999) Two cases of facial neurinoma successfully treated with gamma knife radiosurgery. Neurological Surgery 27:171-175. Reason for exclusion: Incorrect study type Indira Devi B, Panigrahi M, Jaiswal VK, Bhat DI, Das S, and Das BS. (2000) Facial nerve neurinoma presenting as middle cranial fossa and cerebellopontine angle mass: A case report. Neurology India 48:385-387. Reason for exclusion: Incorrect study type Maeta M, Saito R, and Nameki H. (2001) False-positive magnetic resonance image in the diagnosis of small acoustic neuroma. Journal of Laryngology and Otology 115:842844. Reason for exclusion: Incorrect study type

Scott A, D'Souza A, Henderson J, and Morgan DW. (2001) Intracochlea acoustic neuroma: A case report and discussion. European Archives of OtoRhino-Laryngology 258:557-559. Reason for exclusion: Incorrect study type Joseph BV and Rajshekhar V. (2002) Facial myokymia as a presenting symptom of vestibular schwannoma. Neurology India 50:369-370. Reason for exclusion: Incorrect study type Chee NWC and Tong HMH. (2002) Acoustic neuroma presenting as exercise-induced vertigo. Journal of Laryngology and Otology 116:630632. Reason for exclusion: Incorrect study type Branch MP and Hirsch BE. (2002) Management of unilateral acoustic neuroma in a 72-year-old patient with contralateral congenital deafness. Otolaryngology - Head and Neck Surgery 127:483-486. Reason for exclusion: Incorrect study type Meiteles LZ, Liu JK, and Couldwell WT. (2002) Hearing restoration after resection of an intracanalicular vestibular schwannoma: A role for emergency surgery? Case report and review of the literature. Journal of Neurosurgery 96:796-800. Reason for exclusion: Incorrect study type Hegarty JL, Patel S, Fischbein N, Jackler RK, and Lalwani AK. (2002) The value of enhanced magnetic resonance imaging in the evaluation of endocochlear disease. Laryngoscope 112:8-17.

Screening in ASNHL for acoustic neuroma

41 Reason for exclusion: Incorrect study type Yuksel H, Odabasi AR, Kafkas S, Onur E, and Turgut M. (2003) Clitoromegaly in type 2 neurofibromatosis: A case report and review of the literature. European Journal of Gynaecological Oncology 24:447-451. Reason for exclusion: Incorrect study type Ahsan S, Telischi F, Hodges A, and Balkany T. (2003) Cochlear implantation concurrent with translabyrinthine acoustic neuroma resection. Laryngoscope 113:472-474. Reason for exclusion: Incorrect study type Aarnisalo AA, Suoranta H, and Ylikoski J. (2004) Magnetic resonance imaging findings in the auditory pathway of patients with sudden deafness. Otology and Neurotology 25:245-249. Reason for exclusion: Incorrect study type Laudadio P, Berni Canani F, and Cunsolo E. (2004) Meningioma of the internal auditory canal. Acta OtoLaryngologica 124:1231-1234. Reason for exclusion: Incorrect study type Gupta T, Sarin R, Jalali R, and Juvekar S. (2005) Posterior fossa ependymoma: Unusual extension into the internal auditory canal in a 32-year-old woman. Journal of the Hong Kong College of Radiologists 8:109-111. Reason for exclusion: Incorrect study type Karagama YG, Bridges LR, and van Hille PT. (2005) Angioleiomyoma of the internal auditory meatus: a rare occurrence in the internal auditory

canal. Ear, nose, & throat journal 84:216, 218. Reason for exclusion: Incorrect study type Deb P, Sharma MC, Gaikwad S, Gupta A, Mehta VS, and Sarkar C. (2005) Cerebellopontine angle paraganglioma - Report of a case and review of literature. Journal of Neuro-Oncology 74:65-69. Reason for exclusion: Incorrect study type Singh K and Kharrubon B. (2006) Neurofibromatosis type 2: A case report. JMS - Journal of Medical Society 20:153-155. Reason for exclusion: Incorrect study type Wang MT, Chen JC, Tsai TC, Chen TY, Tzeng WS, Mak CW, Tsai JM, and Wu TC. (2006) CT and MR imaging manifestation of lipochoristomas in internal auditory canal: A case report. Chinese Journal of Radiology 31:35-38. Reason for exclusion: Incorrect study type Kernohan MD, Blackmore KJ, Johnson IJM, and Zammit-Maempel I. (2006) Magnetic resonance imaging: Is a single scan ever enough for the diagnosis of acoustic neuroma? Journal of Laryngology and Otology 120:1061-1063. Reason for exclusion: Incorrect study type Fayad JN, Don M, and Linthicum J. (2006) Distribution of low-frequency nerve fibers in the auditory nerve: Temporal bone findings and clinical implications. Otology and Neurotology 27:1074-1077. Reason for exclusion: Incorrect study type

Screening in ASNHL for acoustic neuroma

42 Halefoglu AM. (2007) Neurofibromatosis type 2 associated with multiple cranial nerve schwannomas: a case report. Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat 17:171-175. Reason for exclusion: Incorrect study type Zhang J, Kaga K, and Zheng QY. (2007) Small papillary tumor in the saccule. International Journal of Pediatric Otorhinolaryngology Extra 2:107-110. Reason for exclusion: Incorrect study type

Reason for exclusion: Incorrect study type Bush ML, Jones RO, and Shinn JB. (2008) Auditory brainstem response threshold differences in patients with vestibular schwannoma: A new diagnostic index. Ear, Nose and Throat Journal 87:458-462. Reason for exclusion: Incorrect study type Prasad J and Cousins VC. (2008) Asymmetrical hearing loss. Australian Family Physician 37:312-320. Reason for exclusion: Incorrect study type

Nascentes SM, Paulo EADO, De Andrade EC, Da Silva AL, Vassoler TMF, and Scanavini ABA. (2007) Sudden deafness as a presenting symptom of acoustic neuroma: Case report. Brazilian Journal of Otorhinolaryngology 73:713-716. Reason for exclusion: Incorrect study type

Schaedler A and Hawkins D. (2008) Audiologic management of a patient with a sudden hearing loss and vestibular Schwannoma in the contralateral ear. Journal of the American Academy of Audiology 19:210-214. Reason for exclusion: Incorrect study type

Amit A, Achawal S, and Dorward N. (2008) Pituitary macro adenoma and vestibular schwannoma: A case report of dual intracranial pathologies. British Journal of Neurosurgery 22:695-696. Reason for exclusion: Incorrect study type

Martinez Del Pero M, Moffat D, and Sudhoff H. (2008) Unusual presentation of temporal bone involvement in Churg-Strauss syndrome. Journal of Laryngology and Otology 122:425-427. Reason for exclusion: Incorrect study type

Zanetti D, Campovecchi CB, Pasini S, and Nassif N. (2008) Simultaneous translabyrinthine removal of acoustic neuroma and cochlear implantation. Auris Nasus Larynx 35:562-568. Reason for exclusion: Incorrect study type Prasai A, Jones SEM, Cross J, and Moffat DA. (2008) A facial nerve schwannoma masquerading as a vestibular schwannoma. Ear, Nose and Throat Journal 87:E4.

Shin YR, Choi SJ, Park K, and Choung YH. (2009) Intralabyrinthine schwannoma involving the cochlea, vestibule, and internal auditory canal: 'Canalolabyrinthine schwannoma'. European Archives of Oto-RhinoLaryngology 266:143-145. Reason for exclusion: Incorrect study type Borg E and Lofqvist L. (1982) Auditory brainstem response (ABR) to rarefaction and condensation clicks in

Screening in ASNHL for acoustic neuroma

43 normal and abnormal ears. Scandinavian Audiology 11:227-235. Reason for exclusion: Incorrect patient population Hinojosa R and Marion M. (1983) Histopathology of profound sensorineural deafness. Annals of the New York Academy of Sciences Vol. 405:459-484. Reason for exclusion: Incorrect patient population Jerger S and Jerger J. (1983) Evaluation of diagnostic audiometric tests. Audiology 22:144-161. Reason for exclusion: Incorrect patient population Hirsch A. (1983) The stapedius reflex tests in retrocochlear hearing disorders. Audiology 22:463-470. Reason for exclusion: Incorrect patient population Mafee MF, Kumar A, and Valvassori GE. (1985) Diagnostic potential of CT in neurotological disorders. Laryngoscope 95:505-514. Reason for exclusion: Incorrect patient population Bergenius J. (1985) Vestibular findings in sensorineural hearing disorders. Acta Oto-Laryngologica 99:83-94. Reason for exclusion: Incorrect patient population Campbell KCM and Abbas PJ. (1987) The effect of stimulus repetition rate on the auditory brainstem response in tumor and nontumor patients. Journal of Speech and Hearing Research 30:494-502. Reason for exclusion: Incorrect patient population Jerger J and Johnson K. (1988) Interactions of age, gender, and sensorineural hearing loss on ABR

latency. Ear and Hearing 9:168-176. Reason for exclusion: Incorrect patient population Bonfils P, Uziel A, and Pujol R. (1988) Evoked oto-acoustic emissions from adults and infants: Clinical applications. Acta Oto-Laryngologica 105:445-449. Reason for exclusion: Incorrect patient population Tsirulnikov EM, Vartanyan IA, Gersuni GV, Rosenblyum AS, Pudov VI, and Gavrilov LR. (1988) Use of amplitude-modulated focused ultrasound for diagnosis of hearing disorders. Ultrasound in Medicine and Biology 14:277-285. Reason for exclusion: Incorrect patient population Silverstein H, Norrell H, Smouha E, and Haberkamp T. (1988) The singular canal: A valuable landmark in surgery of the internal auditory canal. Otolaryngology - Head and Neck Surgery 98:138-143. Reason for exclusion: Incorrect patient population Dolan KD and Yuh WTC. (1989) Gadolinium-enhanced facial nerves: Accompanying bilateral acoustic tumors in a patient with neurofibromatosis. Annals of Otology, Rhinology and Laryngology 98:747748. Reason for exclusion: Incorrect patient population Almqvist U, Almqvist B, and Jonsson KE. (1989) Phase audiometry - A rapid method for detecting cerebello-pontine angle tumours? Scandinavian Audiology 18:155-159. Reason for exclusion: Incorrect patient population

Screening in ASNHL for acoustic neuroma

44 Tos M, Trojaborg N, and Thomsen J. (1989) The contralateral ear after translabyrinthine removal of acoustic neuromas: is there a drill-noise generated hearing loss? Journal of Laryngology and Otology 103:845849. Reason for exclusion: Incorrect patient population Bauch CD and Olsen WO. (1989) Wave V interaural latency differences as a function of asymmetry in 2,0004,000 Hz hearing sensitivity. American Journal of Otology 10:389-192. Reason for exclusion: Incorrect patient population Ohlms LA, Lonsbury-Martin BL, and Martin GK. (1991) Acoustic-distortion products: Separation of sensory from neural dysfunction in sensorineural hearing loss in human beings and rabbits. Otolaryngology - Head and Neck Surgery 104:159-174. Reason for exclusion: Incorrect patient population Ogawa K, Kanzaki J, Ogawa S, Tsuchihashi N, and Yamamoto M. (1991) Acoustic neuromas with normal hearing. Acta Oto-Laryngologica, Supplement 487:144-149. Reason for exclusion: Incorrect patient population Ogawa K, Kanzaki J, Ogawa S, Tsuchihashi N, and Inoue Y. (1991) Acoustic neuromas presenting as sudden hearing loss. Acta OtoLaryngologica, Supplement 487:138143. Reason for exclusion: Incorrect patient population Souliere J, Kava CR, Barrs DM, and Bell AF. (1991) Sudden hearing loss as the sole manifestation of neurosarcoidosis. Otolaryngology Head and Neck Surgery 105:376-381.

Reason for exclusion: Incorrect patient population Thompson ME and Abel SM. (1992) Indices of hearing in patients with central auditory pathology. II. Choice response time. Scandinavian Audiology, Supplement 35:17-22. Reason for exclusion: Incorrect patient population Gstoettner W, Neuwirth-Riedl K, Swoboda H, Mostbeck W, and Burian M. (1992) Specificity of auditory brainstem response audiometry criteria in acoustic neuroma screening as a function of deviations of reference values in patients with cochlear hearing loss. European Archives of Oto-Rhino-Laryngology 249:253-256. Reason for exclusion: Incorrect patient population Pappas J, Hoffman RA, Cohen NL, Holliday RA, and Pappas S. (1993) Petrous jugular malposition (diverticulum). Otolaryngology - Head and Neck Surgery 109:847-852. Reason for exclusion: Incorrect patient population Dufour JJ, Michaud LA, Mohr G, Pouliot D, and Picard C. (1994) Intratemporal vascular malformations (angiomas): Particular clinical features. Journal of Otolaryngology 23:250253. Reason for exclusion: Incorrect patient population Moffat DA, Baguley DM, Von Blumenthal H, Irving RM, and Hardy DG. (1994) Sudden deafness in vestibular schwannoma. Journal of Laryngology and Otology 108:116119. Reason for exclusion: Incorrect patient population

Screening in ASNHL for acoustic neuroma

45 Silverstein H, Wanamaker HH, Rosenberg SI, Crosby N, and Flanzer JM. (1994) Promontory testing in neurotologic diagnosis. American Journal of Otology 15:101-107. Reason for exclusion: Incorrect patient population Jacobson GP, Butcher JA, Newman CW, and Monsell EM. (1995) When paroxysmal positioning vertigo isn't benign. Journal of the American Academy of Audiology 6:346-349. Reason for exclusion: Incorrect patient population Hulka GF, Bernard EJ, and Pillsbury HC. (1995) Cochlear implantation in a patient after removal of an acoustic neuroma: The implications of magnetic resonance imaging with gadolinium on patient management. Archives of Otolaryngology - Head and Neck Surgery 121:465-468. Reason for exclusion: Incorrect patient population Lonsbury-Martin BL, Martin GK, McCoy MJ, and Whitehead ML. (1995) New approaches to the evaluation of the auditory system and a current analysis of otoacoustic emissions. Otolaryngology - Head and Neck Surgery 112:50-63. Reason for exclusion: Incorrect patient population Chakrabarti KB, Doughty D, and Plowman PN. (1996) Stereotactic multiple arc radiotherapy. II--Cranial neuroma. British Journal of Neurosurgery 10:577-583. Reason for exclusion: Incorrect patient population Tono T, Ushisako Y, and Morimitsu T. (1997) Cochlear implantation in an intralabyrinthine acoustic neuroma patient after resection of an intracanalicular tumor. Advances in

oto-rhino-laryngology 52:155-157. Reason for exclusion: Incorrect patient population Weber PC, Zbar RI, and Gantz BJ. (1997) Appropriateness of magnetic resonance imaging in sudden sensorineural hearing loss. Otolaryngology - Head and Neck Surgery 116:153-156. Reason for exclusion: Incorrect patient population Aslan A, De Donato G, Balyan FR, Falcioni M, Russo A, Taibah A, and Sanna M. (1997) Clinical observations on coexistence of sudden hearing loss and vestibular schwannoma. Otolaryngology - Head and Neck Surgery 117:580-582. Reason for exclusion: Incorrect patient population Welling DB, Miles BA, Western L, and Prior TW. (1997) Detection of viral DNA in vestibular ganglia tissue from patients with Meniere's disease. American Journal of Otology 18:734737. Reason for exclusion: Incorrect patient population Swartz JD, Harnsberger HR, and Mukherji SK. (1998) The temporal bone: Contemporary diagnostic dilemmas. Radiologic Clinics of North America 36:819-853. Reason for exclusion: Incorrect patient population Ravikumar A, Singh P, and Batish VK. (1999) Vestibular schwanomma with normal hearing. Indian Journal of Otolaryngology and Head and Neck Surgery 51:71-76. Reason for exclusion: Incorrect patient population Sugimoto T, Tsutsumi T, Noguchi Y, Tsunoda A, Kitamura K, and

Screening in ASNHL for acoustic neuroma

46 Komatsuzaki A. (2000) Relationship between cystic change and rotatory vertigo in patients with acoustic neuroma. Acta Oto-Laryngologica, Supplement 542:9-12. Reason for exclusion: Incorrect patient population Driscoll CLW, Jackler RK, Pitts LH, and Brackmann DE. (2000) Lesions of the internal auditory canal and cerebellopontine angle in an only hearing ear: Is surgery ever advisable? American Journal of Otology 21:573581. Reason for exclusion: Incorrect patient population Shaida AM, McFerran DJ, Da Cruz M, Hardy DG, and Moffat DA. (2000) Cavernous haemangioma of the internal auditory canal. Journal of Laryngology and Otology 114:453455. Reason for exclusion: Incorrect patient population Sheykholeslami K, Murofushi T, Kermany MH, and Kaga K. (2000) Bone-conducted evoked myogenic potentials from the sternocleidomastoid muscle. Acta OtoLaryngologica 120:731-734. Reason for exclusion: Incorrect patient population Lesinski-Schiedat A, Frohne C, Illg A, Rost U, Matthies C, Battmer RD, Samii M, and Lenarz T. (2000) Auditory brainstem implant in auditory rehabilitation of patients with neurofibromatosis type 2: Hannover programme. Journal of Laryngology and Otology 114:15-17. Reason for exclusion: Incorrect patient population Adams WM. (2002) Imaging of the cerebellopontine angle. CME Journal Radiology 3:58-65.

Reason for exclusion: Incorrect patient population Anyanwu E, Campbell AW, and High W. (2002) Brainstem auditory evoked response in adolescents with acoustic mycotic neuroma due to environmental exposure to toxic molds. International Journal of Adolescent Medicine and Health 14:67-76. Reason for exclusion: Incorrect patient population Al Sebeih K and Zeitouni A. (2002) Vestibular-evoked myogenic potentials as a test of otolith function. Medical Principles and Practice 11:136-140. Reason for exclusion: Incorrect patient population Hilton MP, Kaplan DM, Ang L, and Chen JM. (2002) Facial nerve paralysis and meningioma of the internal auditory canal. Journal of Laryngology and Otology 116:132-134. Reason for exclusion: Incorrect patient population Eckhardt-Henn A, Breuer P, Thomalske C, Hoffmann SO, and Hopf HC. (2003) Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. Journal of Anxiety Disorders 17:369-388. Reason for exclusion: Incorrect patient population Lonsbury-Martin BL and Martin GK. (2003) Otoacoustic emissions. Current Opinion in Otolaryngology and Head and Neck Surgery 11:361-366. Reason for exclusion: Incorrect patient population Larson TL. (2003) Understanding the posttreatment imaging appearance of the internal auditory canal and cerebellopontine angle. Seminars in Ultrasound CT and MRI 24:133-146.

Screening in ASNHL for acoustic neuroma

47 Reason for exclusion: Incorrect patient population Huang MY and Vermeulen S. (2003) Clinical perspectives regarding patients with internal auditory canal or cerebellopontine angle lesions: Surgical and radiation oncology perspectives. Seminars in Ultrasound CT and MRI 24:124-132. Reason for exclusion: Incorrect patient population Baguley DM, Jones SEM, and Moffat DA. (2003) A small vestibular schwannoma arising from the inferior vestibular nerve. Journal of Laryngology and Otology 117:498500. Reason for exclusion: Incorrect patient population Chandrasekhar SS. (2003) Updates on methods to treat sudden hearing loss. Operative Techniques in Otolaryngology - Head and Neck Surgery 14:288-292. Reason for exclusion: Incorrect patient population Kania RE, Herman P, and Tran Ba Huy P. (2004) Vestibular-like facial nerve schwannoma. Auris Nasus Larynx 31:212-219. Reason for exclusion: Incorrect patient population Abdelkader M, McEwan M, and Cooke L. (2004) Prospective evaluation of the value of direct referral hearing aid clinic in management of young patients with bilateral hearing loss. Clinical Otolaryngology and Allied Sciences 29:206-209. Reason for exclusion: Incorrect patient population Jombik P and Bahyl V. (2005) Short latency disconjugate vestibulo-ocular

responses to transient stimuli in the audio frequency range. Journal of Neurology, Neurosurgery and Psychiatry 76:1398-1402. Reason for exclusion: Incorrect patient population Shah RK, Blevins NH, and Karmody CS. (2005) Mid-frequency sensorineural hearing loss: Aetiology and prognosis. Journal of Laryngology and Otology 119:529-533. Reason for exclusion: Incorrect patient population Choi KD, Cho HJ, Koo JW, Park SH, and Kim JS. (2005) Hyperventilationinduced nystagmus in vestibular schwannoma. Neurology 64:2062. Reason for exclusion: Incorrect patient population Sauvaget E, Kici S, Kania R, Herman P, and Huy PTB. (2005) Sudden sensorineural hearing loss as a revealing symptom of vestibular schwannoma. Acta Oto-Laryngologica 125:592-595. Reason for exclusion: Incorrect patient population Cadoni G, Agostino S, Scipione S, Ippolito S, Caselli A, Marchese R, and Paludetti G. (2005) Sudden sensorineural hearing loss: Our experience in diagnosis, treatment, and outcome. Journal of Otolaryngology 34:395-401. Reason for exclusion: Incorrect patient population Amiridavan M, Nemati S, Hashemi SM, Jamshidi M, Saberi A, and Asadi M. (2006) Otoacoustic emissions and auditory brainstem responses in patiens with sudden sensorineural hearing loss. Do otoacoustic emissions have prognostic value? Journal of Research in Medical Sciences 11:263-269.

Screening in ASNHL for acoustic neuroma

48 Reason for exclusion: Incorrect patient population Cadoni G, Cianfoni A, Agostino S, Scipione S, Tartaglione T, Galli J, and Colosimo C. (2006) Magnetic resonance imaging findings in sudden sensorineural hearing loss. Journal of Otolaryngology 35:310-316. Reason for exclusion: Incorrect patient population Khrais T and Sanna M. (2006) Hearing preservation surgery in vestibular schwannoma. The Journal of laryngology and otology. 120:366-370. Reason for exclusion: Incorrect patient population Chen CC, Cheng PW, Tseng HM, and Young YH. (2006) Posterior cranial fossa tumors in young adults. Laryngoscope 116:1678-1681. Reason for exclusion: Incorrect patient population Lenarz T, Lim HH, Reuter G, Patrick JF, and Lenarz M. (2006) The auditory midbrain implant: A new auditory prosthesis for neural deafness-concept and device description. Otology and Neurotology 27:838-843. Reason for exclusion: Incorrect patient population Sone M, Katayama N, Otake N, Sato E, Fujimoto Y, Ito M, and Nakashima T. (2007) Characterizing the auditory changes in tumor metastasis to the bilateral internal auditory canals. Journal of Clinical Neuroscience 14:470-473. Reason for exclusion: Incorrect patient population Poh ACC and Tiong YT. (2007) Sudden deafness due to intralabyrinthine haemorrhage: A possible rare late complication of head and neck irradiation. Annals of the

Academy of Medicine Singapore 36:78-82. Reason for exclusion: Incorrect patient population Tringali S, Grayeli AB, Bouccara D, Sterkers O, Chardon S, Martin C, and Dubreuil C. (2008) A survey of satisfaction and use among patients fitted with a BAHA. European Archives of Oto-Rhino-Laryngology 265:1461-1464. Reason for exclusion: Incorrect patient population Wenzel GI, Gotz F, Lenarz T, and Stover T. (2008) HIV-associated cerebral lymphocyte infiltration mimicking vestibular schwannoma. European Archives of Oto-RhinoLaryngology 265:1567-1571. Reason for exclusion: Incorrect patient population Tringali S, Marzin A, Dubreuil C, and Ferber-Viart C. (2008) Bone-anchored hearing aid in unilateral inner ear deafness: Electrophysiological results in patients following vestibular schwannoma removal. Acta OtoLaryngologica 128:1203-1210. Reason for exclusion: Incorrect patient population Balbani AP and Montovani JC. (2008) Mobile phones: influence on auditory and vestibular systems. Revista brasileira de otorrinolaringologia (English ed. ) 74:125-131. Reason for exclusion: Incorrect patient population Djupesland G, Flottorp G, Modalsli B, Tvete O, and Sortland O. (1981) Acoustic brain stem response in diagnosis of acoustic neuroma. Scandinavian Audiology, Supplement 13:109-112. Reason for exclusion: Incorrect disease

Screening in ASNHL for acoustic neuroma

49

Sataloff RT. (1986) Sensorineural hearing loss. Otolaryngologic Clinics of North America 19:3-37. Reason for exclusion: Incorrect disease Dauman R, Aran JM, and Portmann M. (1988) Limits of ABR and contribution of transtympanic electrocochleography in the assessment of cerebellopontine angle tumours. Clinical Otolaryngology and Allied Sciences 13:107-114. Reason for exclusion: Incorrect disease Papsin BC and Abel SM. (1988) Temporal summation in hearingimpaired listeners. Journal of Otolaryngology 17:93-100. Reason for exclusion: Incorrect disease Gleeson MJ, Cox TCS, and Strong AJ. (1989) Aneurysm of the anterior inferior cerebellar artery mimicking an intracanalicular acoustic neuroma. Journal of Laryngology and Otology 103:107-110. Reason for exclusion: Incorrect disease Martin GK, Ohlms LA, Franklin DJ, Harris FP, and Lonsbury-Martin BL. (1990) Distortion product emissions in humans. III. Influence of sensorineural hearing loss. Annals of Otology, Rhinology and Laryngology 99:30-42. Reason for exclusion: Incorrect disease Litt AW, Mirsky P, Berson BD, and Kricheff II. (1991) Screening protocol for MR imaging of the internal auditory canal. Journal of Computer Assisted Tomography 15:930-933. Reason for exclusion: Incorrect disease

Anand VT, Byrnes DP, Walby AP, and Kerr AG. (1993) Bilateral acoustic neuromas. Clinical Otolaryngology and Allied Sciences 18:365-371. Reason for exclusion: Incorrect disease Mark AS, Seltzer S, and Harnsberger HR. (1993) Sensorineural hearing loss: More than meets the eye? American Journal of Neuroradiology 14:37-45. Reason for exclusion: Incorrect disease Mukerji B, Estrem SA, and O'Sullivan FX. (1994) The challenge of sensorineural hearing loss in rheumatoid arthritis. Journal of Rheumatology 21:1753-1757. Reason for exclusion: Incorrect disease Lustig LR, Jackler RK, and Chen DA. (1995) Contralateral hearing loss after neurotologic surgery. Otolaryngology Head and Neck Surgery 113:276-282. Reason for exclusion: Incorrect disease Weissman JL. (1996) Hearing loss. Radiology 199:593-611. Reason for exclusion: Incorrect disease Baguley DM, Beynon GJ, Grey PL, Hardy DG, and Moffat DA. (1997) Audio-vestibular findings in meningioma of the cerebellopontine angle: A retrospective review. Journal of Laryngology and Otology 111:10221026. Reason for exclusion: Incorrect disease Zbar RIS, Megerian CA, Khan A, and Rubinstein JT. (1997) Invisible culprit: Intralabyrinthine schwannomas that do not appear on enhanced magnetic resonance imaging. Annals of Otology, Rhinology and Laryngology 106:739-

Screening in ASNHL for acoustic neuroma

50 742. Reason for exclusion: Incorrect disease Daniels RL, Swallow C, Shelton C, Davidson HC, Krejci CS, and Harnsberger HR. (2000) Causes of unilateral sensorineural hearing loss screened by high- resolution fast spin echo magnetic resonance imaging: Review of 1,070 consecutive cases. American Journal of Otology 21:173180. Reason for exclusion: Incorrect disease Ramsden R and Saeed S. (2000) The future of ORL-HNS and associated specialities series: The future of neurootology. Journal of Laryngology and Otology 114:89-92. Reason for exclusion: Incorrect disease Huang TW and Young YH. (2002) Differentiation between cerebellopontine angle tumors in cancer patients. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 23:975-979. Reason for exclusion: Incorrect disease Mendez JC, Saucedo G, Ruiz P, Vega A, and Nombela L. (2002) Lipoma of the internal auditory canal: MR findings [2]. European Radiology 12:703-704. Reason for exclusion: Incorrect disease Glastonbury CM, Davidson HC, Harnsberger HR, Butler J, Kertesz TR, and Shelton C. (2002) Imaging findings of cochlear nerve deficiency. American Journal of Neuroradiology 23:635-643.

Reason for exclusion: Incorrect disease Rebol J, Munda A, and Tos M. (2004) Hyperpneumatization of the temporal, occipital and parietal bones. European Archives of Oto-Rhino-Laryngology 261:445-448. Reason for exclusion: Incorrect disease Oghalai JS, Ramirez AL, Hegarty JL, and Jackler RK. (2004) Chronic pachymeningitis presenting as asymmetric sensorineural hearing loss. Otology and Neurotology 25:616-621. Reason for exclusion: Incorrect disease Crummer RW and Hassan GA. (2004) Diagnostic Approach to Tinnitus. American Family Physician 69:120126+127. Reason for exclusion: Incorrect disease Marcucci R, Liotta AA, Cellai AP, Rogolino A, Berloco P, Leprini E, Pagnini P, Abbate R, and Prisco D. (2005) Cardiovascular and thrombophilic risk factors for idiopathic sudden sensorineural hearing loss. Journal of Thrombosis and Haemostasis 3:929-934. Reason for exclusion: Incorrect disease Sen A, Khan MIJ, Ramsden RT, and Gillespie JE. (2005) Stenosis of the internal auditory meatus masquerading as bilateral vestibular schwannomas: A cautionary tale. Journal of Laryngology and Otology 119:995997. Reason for exclusion: Incorrect disease Gonul E, Izci Y, and Onguru O. (2007) Arachnoid cyst of the cerebellopontine angle associated with gliosis of the

Screening in ASNHL for acoustic neuroma

51 eighth cranial nerve. Journal of Clinical Neuroscience 14:700-702. Reason for exclusion: Incorrect disease Preuss M, Stein M, Huegens-Penzel M, Kuchelmeister K, and Nestler U. (2008) Metastatic tumours mimicking vestibular schwannoma. Acta Neurochirurgica 150:915-919. Reason for exclusion: Incorrect disease Muzzi E, Rinaldo A, and Ferlito A. (2008) Meniere disease: diagnostic instrumental support. American Journal of Otolaryngology - Head and Neck Medicine and Surgery 29:188194. Reason for exclusion: Incorrect disease Neely JG, Britton BH, and Greenberg SD. (1976) Microscopic characteristics of the acoustic tumor in relationship of its nerve of origin. Laryngoscope 86:984-991. Reason for exclusion: Incorrect intervention/outcomes Mathew GD, Facer GW, Suh KW, Houser OW, and O'Brien PC. (1978) Symptoms, findings, and methods of diagnosis in patients with acoustic neuroma. Laryngoscope 88:1893-1903, 1921. Reason for exclusion: Incorrect intervention/outcomes Nager GT. (1984) Neurinomas of the trigeminal nerve. American Journal of Otolaryngology - Head and Neck Medicine and Surgery 5:301-333. Reason for exclusion: Incorrect intervention/outcomes Valvassori GE. (1984) Radiologic evaluation of eighth nerve tumors. American Journal of Otolaryngology Head and Neck Medicine and Surgery

5:270-280. Reason for exclusion: Incorrect intervention/outcomes Sturzebecher E, Kevanishvili Z, and Werbs M. (1985) Interpeak intervals of auditory brainstem response, interaural differences in normal-hearing subjects and patients with sensorineural hearing loss. Scandinavian Audiology 14:8387. Reason for exclusion: Incorrect intervention/outcomes Mikaelian DO, Eyyunni U, Osterholm J, Fariello R, and Jassal SP. (1985) Hearing preservation in surgery for acoustic neuroma. Transactions Pennsylvania Academy of Ophthalmology and Otolaryngology 37:255-258. Reason for exclusion: Incorrect intervention/outcomes Jay WM and Williamson MR. (1987) Incidence of subcortical lesions not increased in nonarteritic ischemic optic neuropathy on magnetic resonance imaging. American Journal of Ophthalmology 104:398-400. Reason for exclusion: Incorrect intervention/outcomes Symon L, Sabin HI, Bentivoglio P, Cheesman AD, Prasher D, and Barratt H. (1988) Intraoperative monitoring of the electrocochleogram and the preservation of hearing during acoustic neuroma excision. Acta Neurochirurgica, Supplement 42:2730. Reason for exclusion: Incorrect intervention/outcomes Clemis JD, Toriumi DM, and Gavron JP. (1988) Otosclerosis masking coexistent acoustic neuroma. American Journal of Otology 9:117-121. Reason for exclusion: Incorrect intervention/outcomes

Screening in ASNHL for acoustic neuroma

52 Armington WG, Harnsberger HR, Smoker WRK, and Osborn AG. (1988) Normal and diseased acoustic pathway: Evaluation with MR imaging. Radiology 167:509-515. Reason for exclusion: Incorrect intervention/outcomes Tos M, Thomsen J, and Harmsen A. (1988) Is preservation of hearing in acoustic neuroma worthwhile? Acta Oto-Laryngologica, Supplement 452:57-68. Reason for exclusion: Incorrect intervention/outcomes Moffat DA, Baguley DM, Hardy DG, and Tsui YN. (1989) Contralateral auditory brainstem response abnormalities in acoustic neuroma. Journal of Laryngology and Otology 103:835-838. Reason for exclusion: Incorrect intervention/outcomes Benecke J. (1989) Diagnosis and management of acoustic tumors: An overview. Seminars in Hearing 10:307-312. Reason for exclusion: Incorrect intervention/outcomes Ohlms LA, Lonsbury-Martin BL, and Martin GK. (1990) The clinical application of acoustic distortion products. Otolaryngology - Head and Neck Surgery 103:52-59. Reason for exclusion: Incorrect intervention/outcomes

neuromas. Acta Oto-Laryngologica, Supplement 487:133-137. Reason for exclusion: Incorrect intervention/outcomes Hoffman RA, Kohan D, and Cohen NL. (1992) Cochlear implants in the management of bilateral acoustic neuromas. American Journal of Otology 13:525-528. Reason for exclusion: Incorrect intervention/outcomes Shusterman D, Handler SD, Marsh RR, Bilaniuk L, and Tom LWC. (1992) Usefulness of computed tomographic scan in the evaluation of sensorineural hearing loss in children. Archives of Otolaryngology - Head and Neck Surgery 118:501-503. Reason for exclusion: Incorrect intervention/outcomes Helms J. (1992) Hearing preservation in acoustic neurinoma surgery. Otolaryngologia Polska 46:533-537. Reason for exclusion: Incorrect intervention/outcomes Shaan M, Vassalli L, Landolfi M, Taibah A, Russo A, and Sanna M. (1993) Atypical presentation of acoustic neuroma. Otolaryngology Head and Neck Surgery 109:865-870. Reason for exclusion: Incorrect intervention/outcomes

Hutman S. (1991) New approaches to acoustic neuroma surgery. Journal of clinical laser medicine & surgery 9:168-175. Reason for exclusion: Incorrect intervention/outcomes

Florentine M, Reed CM, Rabinowitz WM, Braida LD, Durlach NI, and Buus S. (1993) Intensity perception. XIV. Intensity discrimination in listeners with sensorineural hearing loss. Journal of the Acoustical Society of America 94:2575-2586. Reason for exclusion: Incorrect intervention/outcomes

Ogawa K, Kanzaki J, Ogawa S, Tsuchihashi N, and Ikeda S. (1991) Progression of hearing loss in acoustic

Bu-Saba NY, Rebeiz EE, Salman SD, Thornton AR, and West C. (1994) Significance of false-positive auditory

Screening in ASNHL for acoustic neuroma

53 brainstem response: A clinical study. American Journal of Otology 15:233236. Reason for exclusion: Incorrect intervention/outcomes Mark AS. (1994) Contrast-enhanced magnetic resonance imaging of the temporal bone. Neuroimaging Clinics of North America 4:117-131. Reason for exclusion: Incorrect intervention/outcomes Moller A, Mytseth E, Jensen O, and and-Pedersen PH. (1995) Acoustic Neuroma: Observation, Surgery or Gamma-knife treatment. 2nd. International Conference on Acoustic. Neuroma. Surgery and 2nd. European Skull. Base. Society Congress. . Paris, France, 22. 26. April. , 1995.68, Abstract. Reason for exclusion: Incorrect intervention/outcomes Walsted A, Salomon G, Thomsen J, and Tos M. (1996) Cerebrospinal fluid loss and threshold changes. 1. Hearing loss in the contralateral ear after operation for acoustic neuroma: an analysis of the incidence, time course, frequency range, size and pathophysiological considerations. Audiology & neuro-otology 1:247-255. Reason for exclusion: Incorrect intervention/outcomes Tanaka H, Komatsuzaki A, and Hentona H. (1996) Usefulness of auditory brainstem responses at high stimulus rates in the diagnosis of acoustic neuroma. ORL 58:224-228. Reason for exclusion: Incorrect intervention/outcomes Nadol J, Diamond PF, and Thornton AR. (1996) Correlation of hearing loss and radiologic dimensions of vestibular schwannomas (acoustic neuromas). American Journal of

Otology 17:312-316. Reason for exclusion: Incorrect intervention/outcomes Held P, Fellner C, Fellner F, Seitz J, Graf S, Hilbert M, and Strutz J. (1997) MRI of inner ear and facial nerve pathology using 3D MP-RAGE and 3D CISS sequences. The British Journal of Radiology 70:558-566. Reason for exclusion: Incorrect intervention/outcomes Hung TY, Litofsky NS, Smith TW, and Megerian CA. (1997) Ganglionic hamartoma of the intracanalicular acoustic nerve causing sensorineural hearing loss. American Journal of Otology 18:498-500. Reason for exclusion: Incorrect intervention/outcomes Davis NL, Rappaport JM, and MacDougall JC. (1997) Cochlear and auditory brainstem implants in the management of acoustic neuroma and bilateral acoustic neurofibromatosis. McGill Journal of Medicine 3:115-120. Reason for exclusion: Incorrect intervention/outcomes Heier LA, Comunale J, and Lavyne MH. (1997) Sensorineural hearing loss and cerebellopontine angle lesions. Not always an acoustic neuroma - A pictorial essay. Clinical Imaging 21:213-223. Reason for exclusion: Incorrect intervention/outcomes Mangham CA. (1997) Expert opinion on the diagnosis of acoustic tumors. Otolaryngology - Head and Neck Surgery 117:622-627. Reason for exclusion: Incorrect intervention/outcomes Qiu WW, Stucker FJ, and Welsh LW. (1998) Clinical interpretations of transient otoacoustic emissions.

Screening in ASNHL for acoustic neuroma

54 American Journal of Otolaryngology Head and Neck Medicine and Surgery 19:370-378. Reason for exclusion: Incorrect intervention/outcomes Ross GJ. (1998) Acoustic neuroma (vestibular schwannoma). New England Journal of Medicine 339:1440. Reason for exclusion: Incorrect intervention/outcomes Marple BF, Milchbrub S, Meyerhoff WL, and Roland PS. (1998) Necrotizing granulomatous inflammation of the superior vestibular nerve mimicking an acoustic neuroma. Otolaryngology - Head and Neck Surgery 118:862-865. Reason for exclusion: Incorrect intervention/outcomes Poen JC, Golby AJ, Forster KM, Martin DP, Chinn DM, Hancock SL, Adler JR, Gutin PH, Lunsford LD, Friedman WA, Samii M, and Matthies C. (1999) Fractionated stereotactic radiosurgery and preservation of hearing in patients with vestibular schwannoma: A preliminary report. Neurosurgery 45:1299-1307. Reason for exclusion: Incorrect intervention/outcomes

Haapaniemi J, Laurikainen E, Johansson R, Miettinen S, and Varpula M. (2000) Cochleovestibular symptoms related to the site of vestibular schwannoma. Acta OtoLaryngologica, Supplement 543:14-16. Reason for exclusion: Incorrect intervention/outcomes Quaranta A, Gandolfi A, Fava G, Quaranta N, and Zini C. (2000) Paradoxical effects of contralateral white noise on evoked otoacoustic emissions in ears with acoustic neuroma. Acta Oto-Laryngologica 120:227-230. Reason for exclusion: Incorrect intervention/outcomes Eisenman DJ and Arts HA. (2000) Effectiveness of treatment for sudden sensorineural hearing loss. Archives of Otolaryngology - Head and Neck Surgery 126:1161-1164. Reason for exclusion: Incorrect intervention/outcomes Harner SG, Fabry DA, and Beatty CW. (2000) Audiometric findings in patients with acoustic neuroma. American Journal of Otology 21:405411. Reason for exclusion: Incorrect intervention/outcomes

Yokoyama K, Nishida H, Noguchi Y, and Komatsuzaki A. (1999) Hearing impairment in patients with acoustic neuroma - Analysis by electrocochleography. Auris Nasus Larynx 26:401-409. Reason for exclusion: Incorrect intervention/outcomes

Noguchi Y, Komatsuzaki A, and Nishida H. (2000) Electrocochleographic study in patients with vestibular schwannomas and Ushaped audiograms. Audiology 39:1923. Reason for exclusion: Incorrect intervention/outcomes

Hellman RP. (1999) Cross-modality matching: A tool for measuring loudness in sensorineural impairment. Ear and Hearing 20:193-213. Reason for exclusion: Incorrect intervention/outcomes

Klingebiel R, Bockmuhl U, Werbs M, Freigang B, Vorwerk W, Thieme N, and Lehmann R. (2001) Visualization of inner ear dysplasias in patients with sensorineural hearing loss. Acta Radiologica 42:574-581.

Screening in ASNHL for acoustic neuroma

55 Reason for exclusion: Incorrect intervention/outcomes Kallinen J, Laurikainen E, Bergroth L, and Grenman R. (2001) A follow-up study of patients suffering from sudden sensorineural hearing loss. Acta OtoLaryngologica 121:818-822. Reason for exclusion: Incorrect intervention/outcomes Friedman RA, Kesser BW, Slattery 3rd. WH, Brackmann DE, and Hitselberger WE. (2001) Hearing preservation in patients with vestibular schwannomas with sudden sensorineural hearing loss. Otolaryngology - Head and Neck Surgery 125:544-551. Reason for exclusion: Incorrect intervention/outcomes Zubay G and Porter RW. (2001) Preoperative assessment of patients with acoustic neuromas. Operative Techniques in Neurosurgery 4:11-18. Reason for exclusion: Incorrect intervention/outcomes Kothari P and Kukreja N. (2001) Intratympanic dexamethasone for sudden sensorineural hearing loss: Clinical and laboratory evaluation. Chandrasekhar SS. Otology & Neurotology 2001; 22: 18-23. CME Bulletin Otorhinolaryngology Head and Neck Surgery 5:108-109. Reason for exclusion: Incorrect intervention/outcomes Magliulo G, Zardo F, Bertin S, D'Amico R, and Savastano V. (2002) Meningiomas of the internal auditory canal: Two case reports. Skull Base 12:19-26. Reason for exclusion: Incorrect intervention/outcomes Jereczek-Fossa BA, Zarowski A, Milani F, and Orecchia R. (2003)

Radiotherapy-induced ear toxicity. Cancer Treatment Reviews 29:417430. Reason for exclusion: Incorrect intervention/outcomes Magliulo G, Gagliardi M, Appiani GC, and D'Amico R. (2003) Preservation of the saccular nerve and of the vestibular evoked myogenic potential during vestibular schwannoma surgery. Otology and Neurotology 24:308-311. Reason for exclusion: Incorrect intervention/outcomes Niparko JK, Cox KM, and Lustig LR. (2003) Comparison of the bone anchored hearing aid implantable hearing device with contralateral routing of offside signal amplification in the rehabilitation of unilateral deafness. Otology and Neurotology 24:73-78. Reason for exclusion: Incorrect intervention/outcomes Nikolopoulos TP and Kiprouli K. (2004) Cochlear implant surgery in challenging cases. Cochlear Implants International 5:56-63. Reason for exclusion: Incorrect intervention/outcomes Hol MKS, Bosman AJ, Snik AFM, Mylanus EAM, and Cremers CWRJ. (2004) Bone-anchored hearing aid in unilateral inner ear deafness: A study of 20 patients. Audiology and NeuroOtology 9:274-281. Reason for exclusion: Incorrect intervention/outcomes Mawman DJ, Bhatt YM, Green KMJ, O'Driscoll MP, Saeed SR, and Ramsden RT. (2004) Trends and outcomes in the Manchester adult cochlear implant series. Clinical Otolaryngology and Allied Sciences 29:331-339.

Screening in ASNHL for acoustic neuroma

56 Reason for exclusion: Incorrect intervention/outcomes Rutherford SA and King AT. (2005) Vestibular schwannoma management: what is the 'best' option? (Brief record). British Journal of Neurosurgery 19:309-316. Reason for exclusion: Incorrect intervention/outcomes Magliulo G, D'Amico R, Celebrini A, and Cuiuli G. (2005) Postoperative Ramsay-Hunt syndrome after acoustic neuroma resection. Viral reactivation. Anales otorrinolaringologicos iberoamericanos 32:253-259. Reason for exclusion: Incorrect intervention/outcomes Moller AR. (2006) History of cochlear implants and auditory brainstem implants. Møller AR (ed): Cochlear and Brainstem Implants. Adv Otorhinolaryngoll 64:1–10 Reason for exclusion: Incorrect intervention/outcomes Sazgar AA, Akrami K, Akrami S, and Karimi Yazdi AR. (2006) Recording of vestibular evoked myogenic potentials. Acta Medica Iranica 44:13-16. Reason for exclusion: Incorrect intervention/outcomes Mazzoni A, Dubey SP, Poletti AM, and Colombo G. (2007) Sporadic acoustic neuroma in pediatric patients. International Journal of Pediatric Otorhinolaryngology 71:1569-1572. Reason for exclusion: Incorrect intervention/outcomes Mackle T, Rawluk D, and McConn Walsh R. (2007) Atypical clinical presentations of vestibular schwannomas. Otology and Neurotology 28:526-528. Reason for exclusion: Incorrect intervention/outcomes

Neff BA, Wiet RM, Lasak JM, Cohen NL, Pillsbury HC, Ramsden RT, and Welling DB. (2007) Cochlear implantation in the neurofibromatosis type 2 patient: Long-term follow-up. Laryngoscope 117:1069-1072. Reason for exclusion: Incorrect intervention/outcomes Ubell ML, Ho KC, Meyer GA, and Friedland DR. (2007) Simultaneous astrocytoma and vestibular schwannoma arising from the vestibulocochlear nerve. Otology and Neurotology 28:286-287. Reason for exclusion: Incorrect intervention/outcomes House JW and Kutz J. (2007) Boneanchored hearing aids: Incidence and management of postoperative complications. Otology and Neurotology 28:213-217. Reason for exclusion: Incorrect intervention/outcomes Penido NDO, Tangerina RP, Kosugi EM, De Abreu CEC, and Vasco MB. (2007) Vestibular Schwannoma: Spontaneous tumor involution. Brazilian Journal of Otorhinolaryngology 73:867-871. Reason for exclusion: Incorrect intervention/outcomes Liu JK, Sayama CM, Shelton C, and MacDonald JD. (2007) Transient facial nerve palsy after topical papaverine application during vestibular schwannoma surgery: Case report. Journal of Neurosurgery 107:10391042. Reason for exclusion: Incorrect intervention/outcomes Shelfer J, Zapala D, and Lundy L. (2008) Fall risk, vestibular schwannoma, and anticoagulation therapy. Journal of the American Academy of Audiology 19:237-245.

Screening in ASNHL for acoustic neuroma

57 Reason for exclusion: Incorrect intervention/outcomes Margolis RH and Saly GL. (2008) Asymmetric hearing loss: definition, validation, and prevalence. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 29:422-431. Reason for exclusion: Incorrect intervention/outcomes Toh EH and Luxford WM. (2008) Cochlear and Brainstem Implantation. Neurosurgery Clinics of North America 19:317-329. Reason for exclusion: Incorrect intervention/outcomes Bischoff B, Romstock J, Fahlbusch R, Buchfelder M, and Strauss C. (2008) Intraoperative brainstem auditory evoked potential pattern and perioperative vasoactive treatment for hearing preservation in vestibular schwannoma surgery. Journal of Neurology, Neurosurgery, and Psychiatry 79:170-175. Reason for exclusion: Incorrect intervention/outcomes

Dell'Aringa AHB, Sena LFP, Teixeira R, Dell'Aringa AR, and Nardi JC. (2008) The importance of the auditory evoked potential in acoustic neuromas. Brazilian Journal of Otorhinolaryngology 74:639. Reason for exclusion: Incorrect intervention/outcomes

Screening in ASNHL for acoustic neuroma