{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:05:04Z","timestamp":1791889504634,"version":"4.3.4"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2016,12,1]],"date-time":"2016-12-01T00:00:00Z","timestamp":1480550400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Health Care Efficiency Research"},{"name":"The Netherlands Organization for Health Research and Development (ZonMw)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Currently, all patients presenting with asymmetrical sensorineural hearing loss and\/or unilateral audiovestibular dysfunction (i.e. tinnitus, dizziness) undergo <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>, leading to a substantial amount of <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>s with negative findings as the incidence of vestibular schwannoma (VS) in this screening population varies between 1% and 4.7% (i.e. more than 95% of <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>s are negative for VS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective of review<\/jats:title><jats:p>The aim was to assess the diagnostic accuracy of different non\u2010imaging screening protocols that can be used prior to <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> to select patients at high risk of VS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Type of review<\/jats:title><jats:p>Diagnostic review and meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>We systematically searched <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>, Embase and The Cochrane Library as from inception up to 28 July 2016. We included studies that compared non\u2010imaging screening protocols to <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> as gold reference standard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evaluation method<\/jats:title><jats:p>Methodological quality was assessed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Data necessary to complete 2 \u00d7 2 tables were obtained, and patient, study, screening and imaging characteristics were extracted. We calculated sensitivity and specificity of all tests and obtained pooled estimates using a bivariate random effects model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We analysed 12 studies (4969 patients) of poor to moderate quality according to the quality assessment. Most studies tested diagnostic accuracy of multiple screening protocols. Five pure\u2010tone audiometry (PTA) protocols were studied by multiple authors; pooled estimates for sensitivity ranged from 88% [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 84\u201391] to 91% [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 52\u201399] and specificity from 31% [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 10\u201366] to 58% [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 49\u201365]. Due to heterogeneity, we were unable to pool other tests. In five studies testing auditory brainstem response, sensitivity values ranged from 37% [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 23\u201352] to 100% [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 40\u2013100] and specificity from 57% to 96% [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 87\u2013100]. Two authors studied PTA shape as a screening test. Presenting symptoms, electronystagmography, caloric irrigation and hyperventilation test were assessed by one study each. All reported low diagnostic accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>All identified studies had a moderate\u2010to\u2010high risk of bias, and none of the currently available non\u2010imaging screening protocols appear to be accurate in detecting VSs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12788","type":"journal-article","created":{"date-parts":[[2016,11,5]],"date-time":"2016-11-05T05:05:07Z","timestamp":1478322307000},"page":"815-823","source":"Crossref","is-referenced-by-count":31,"title":["The diagnostic accuracy of non\u2010imaging screening protocols for vestibular schwannoma in patients with asymmetrical hearing loss and\/or unilateral audiovestibular dysfunction: a diagnostic review and meta\u2010analysis"],"prefix":"10.1111","volume":"42","author":[{"given":"M.","family":"Hentschel","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Scholte","sequence":"additional","affiliation":[{"name":"Department of Operating Rooms Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Steens","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Kunst","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Rovers","sequence":"additional","affiliation":[{"name":"Department of Operating Rooms Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The Netherlands"},{"name":"Department of Health Evidence Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,12]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"690","article-title":"Incidence of vestibular schwannoma in Denmark 1977\u20131995","volume":"21","author":"Howitz M.F.","year":"2000","journal-title":"Am. 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