Dr Philippa Ross
House Officer, Southern DHB, Dunedin, New Zealand
Philippa Ross is a PGY2 House Officer working at Dunedin Hospital. She has an interest in how protocols can be used to increase efficiency and reduce waste in the health system.
Screening for Vestibular Schwannoma – Problems and Paradigms
Historically, Vestibular Schwannoma (VS) have been difficult to diagnose, with subsequent treatment associated with high morbidity and mortality. Advances in both diagnostic technologies and surgical techniques have resulted in enhanced outcomes for patients along with a trend towards earlier diagnosis. While MRI is well established as the gold standard of diagnosis, diagnostic yield remains low, in part because of the wide clinical variability in presentation. The problem of whom to screen, and using which criteria, remains relevant in the current context.
A number of different criteria have been put forward as potentially useful screening protocols, typically based around an audiometric criteria of asymmetrical sensorineural hearing loss, with or without some other stand-alone indicators. In New Zealand different guidelines are in use (i.e. those of the New Zealand Society of ORLHNS (NZSOHNS) and the New Zealand Audiological Society (NZAS)) leading to confusion between professional groups around which patients should be referred for ORL opinion.
Here we will review recent literature describing paradigms for VS screening, discussing the trade-off between sensitivity and specificity, and the costs associated with each, both in terms of resource allocation and the cost-burden of a diagnosis, and the risk of false-negative or missed cases.