Presenting Complaint and Diagnostic Yield of <scp>MRIs</scp> for Vestibular Schwannomas

OBJECTIVE: To ascertain the diagnostic yield of MRIs to diagnose vestibular schwannoma based on the patient's presenting symptoms and age. METHOD: A retrospective cohort study at a single centre. All MRIs ordered by otolaryngologists from 01/01/2022 to 31/12/2023 for the purpose of diagnosing a vestibular schwannoma were included. Data on presenting symptoms, audiogram results, demographics and management outcomes were extracted from clinical records. RESULTS: 1814 MRIs were included. The overall diagnostic yield of vestibular schwannomas was 1.65% (30 cases). Mild asymmetrical sensorineural hearing loss alone (defined as < 15 dB difference between ears at two consecutive frequencies) was not associated with vestibular schwannoma; no patients with this finding were diagnosed (p = 0.025). On multivariate analysis, vertigo (odds ratio [OR] 4.03, p < 0.001) and severe asymmetrical sensorineural hearing loss (OR 5.26, p = 0.002) were independently associated with a diagnosis. Unilateral tinnitus (OR 2.10, p = 0.062), sudden onset asymmetrical hearing loss (OR 0.57, p = 0.46), mild asymmetrical hearing loss (OR 1.03, p = 0.98), or age (OR 0.74, p = 0.48) were not significantly associated with a vestibular schwannoma. Incidental findings were common (23%) and most patients (80%) were managed conservatively with serial MRIs. There was no correlation between age and likelihood of diagnosis. CONCLUSIONS: The diagnostic yield of MRIs for vestibular schwannomas is low. Patients with isolated mild asymmetrical hearing loss alone may not warrant further investigation. Presenting with unilateral tinnitus was a poor discriminator for a diagnosis of vestibular schwannomas. However, patients with unexplained vertigo should be considered for an MRI. Further research is needed to refine current guidelines.