Asymmetric sensorineural hearing loss in the diagnosis of vestibular schwannoma

Hipoacusia sensorineural asimétrica en el diagnóstico de schwannoma vestibular


Background:  It is described that 2% of patients with asymmetric hearing loss have retrocochlear lesions. The scrutiny behavior has been based on audiometry. There are several definitions of audiometric asymmetry described in the literature, but without reaching a consensus. Although the gold standard for the diagnosis of vestibular schwannoma is gadolinium magnetic resonance imaging, the clinical suspicion is based on audiometric asymmetry.

Objective: we review the results published in this regard in the literature and comment on our own experience.

Reflection: we want to emphasize the importance of studying asymmetric hearing loss patients in order to rule out retrocochlear etiology.

Conclusions: although there is no clear consensus on the definition of asymmetric hearing loss, the clinical suspicion of a vestibular schwannoma is based on the audiometry.


Download data is not yet available.

Citado por


Heloisa Coutinho de Toledo
Erika Celis-Aguilar


Welling DB., Glasscock ME, Woods CI., Jackson CG. Acoustic neuroma: a cost effective approach. Otolaryngol Head Neck Surg. 1990; 103:364-70. doi:

Bhargava EK, Coyle P, Wong B, Masood A, Qayyum A. To scan or not to scan – a cross-sectional analysis of the clinical efficacy and cost-effectiveness of audiometric protocols for magnetic resonance imaging screening of vestibular schwannomas. Otol & Neurotol. 2019;40(5S):S59-66. doi:

Murphy M, Selesnick S. Cost effective diagnosis of acoustic neuroma: a philosophical, macroeconomic and technological decision. Otolaryngol Head Neck Surg. 2002; 127:253-9. doi:_

Novak MA. Hearing loss in Neurotologic Diagnosis. En: Jackler R, Brackmann D, editors. Neurotology. Maryland Heights: Mosby; 1994. p. 131-144.

Selesnick SH, Jackler RK, Pitts LW. The changing clinical presentation of acoustic tumors in the MRI era. Laryngoscope. 1993;103:431-436. doi:

Urben S., Benninger M., Gibbens N. Asymmetric sensorineural hearing loss in a community based population. Otolaryngol Head Neck Surg. 1999; 120:808-14. doi:

Kanzaki J, Ogawa K, Ogawa S, Yamamoto M, Ikeda S, O-uchi T. Audiologic findings in acoustic neuroma. Acta Otolaryngol Suppl. 1991;487:125-32. doi:

Stangerup S, Thomasen P, Tos M, Thomsen J. The natural history of vestibular schwannoma. Otol Neurotol. 2006;37:547-552. doi:

Nikolopuolos T, Fortum H, O’Donoghue G, Baguley D. Acoustic Neuroma Growth: a systematic review of the evidence. Otol Neurotol. 2010;31:478-485. doi:

Lusting LR, Rifkin S, Jackler R, Pitts LW. Acoustic neuromas presenting with normal or symmetrical hearing: Factors associated with diagnosis and outcome. Am J Otology. 1998;19:212-218. PMID:9520059

Hentschel M, Scholte M, Steens S, Kunst H, Rovers M. The diagnostic accuracy of non‐imaging screening protocols for vestibular schwannoma in patients with asymmetrical hearing loss and/or unilateral audiovestibular dysfunction: a diagnostic review and meta‐analysis. Clin Otolaryngol. 2017;42(4):815-23. doi:

Nouraei SA, Huys QJ, Chatrath P, Powles J, Harcourt JP. Screening patients with sensorineural hearing loss for vestibular schwannoma using a Bayesian classifier. Clin Otolaryngol. 2007; 32(4):248-54. doi:

Cheng TC, Wareing MJ. Three-year ear, nose, and throat cross-sectional analysis of audiometric protocols for magnetic resonance imaging screening of acoustic tumors. Otolaryngol Head Neck Surg. 2012;146(3):438-47. doi:

Sheppard IJ, Milford CAM, Anslow P. MRI in the detection of acoustic neuromas: a suggested protocol for screening. Clin Otolaryngol. 1996;21:301-304. doi:

Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). Otolaryngol Head Neck Surg. 1995;113:179-180. doi:

Magham CA. Hearing threshold difference between ears and risk of acoustic tumor. Otolaryngol Head Neck Surg. 1991;105:814-7. doi:

Margolis RH., Saly GL. Asymmetric hearing loss: definition, validation and prevalence. Otol Neurootol. 2008;29:422-31. doi:

Saliba I, Martineau G, Chagnon M. Asymmetric hearing loss: rule 3000 for screening vestibular asymmetric sensorineural hearing loss. Laryngoscope. 2004;114:1686-1692. doi:

Lassaletta L, Calvino M, Morales-Puebla JM, Lapunzina P, la Rosa Rodriguez-de L., Varela-Nieto I, et al. Biomarkers in Vestibular Schwannoma–Associated Hearing Loss. Front Neurol. 2019;10. doi:

Schlauch RS, Levine S. Evaluating hearing threshold differences between ears as a screen for acoustic neuroma. J Speech Hear Res. 1995; 38:1168-1175. doi:

Cueva RA. Auditory brainstem response versus magnetic resonance imaging for the evaluation of asymmetric sensorineural hearing loss. Laryngoscope. 2004;114:1686-1692. doi:

Lehnhardt E. Neuro-axonal recruitment: a result of selective compression. J Laryngol Otol. 1990;104:185-190. doi:

Lonsburry-Martin BL, McCoy M. Otoacoustic emissions: future directions for research and clinical applications. The Hearing Journal. 1992;45:47-52. doi: https.//

Cane MA, Lutman ME. Transiently evoked otoacoustic emissions in patients with cerebellopontine angle tumors. Am J Otology. 1994;15:207-216. PMID: 8172303

Norman M; Thornton A. Otoacoustic emissions recorded at high rates in patients with confirmed acoustic neuromas. Am J Otol. 1996;17:736-772. PMID: 3202131

Telishi FF, Stanger B, Widick MP, Balkany TJ, Lonsbury-Martin BL. Distortion-product otoacoustic emission monitoring of cochlear blood flow. Laryngoscope. 1998;108(6):837-842. doi:

Kagoya R, Shinogami M, Kohno M, Yamasoba T. Distortion-product otoacoustic emission test evaluate cochlear function and differentiate cochlear and vestibular schwannoma. Otolaryngol Head Neck Surg. 2013 Feb;148(29):26771. doi:

Telian S, Kileny P, Niparko J. Normal auditory brainstem response in patients with acoustic neuroma. Laryngoscope. 1989;99:10-14. doi:

Wilson D, Hodgson R, Gustafson M. The sensitivity of auditory brainstem response testing in small acoustic neuromas. Laryngoscope. 1992;102:961-964. doi:

Zappia J, O’Connor CA. Rethinking the use of auditory brainstem response in acoustic neuroma screening. Laryngoscope. 1997;107:1388-1392. doi:

Toledo H, Pane C. Potenciales evocados auditivos de tallo cerebral. En: PAC Otorrino-1, SMORL y CCC. México: Intersistemas; 1999. p. 11-19.

Bauch CD, Olsen WO, Pool A. ABR indices: sensitivity, specificity, and tumor size. Am J Audiol. 1996;5:97-104. doi:

Selters W, Brackmann D. Acoustic tumor detection with brainstem electric response audiometry. Arch Otolaryngol. 1977;103:181-187. doi:

Don M. Auditory brainstem response testing in acoustic neuroma diagnosis. Curr Opin Otolaryngol Head Neck Sur. 2002;10:376-381. doi: https.//

Don M, Kwong B, Tanaka C, Brackmann D. The stacked ABR: a sensitive and specific screening tool for detecting small acoustic tumors. Audiol Neurotol. 2005;10:274-290. doi:

Elberling C, Don M, Kristensen A. Auditory brainstem responses to chirps delivered by an insert earphone with equalized frequency response. J Acoust Soc Am. 2012 Aug;132(2):EL149-54. doi:

Kochanek K, Sliwa L, Gotebiowski M, Pitka A, Skarzynski H. Comparison of 3 ABR methods for diagnosis of retrocochlear hearing impairment. Med Sci Monit. 2015;21:3814-3824. doi: https/

Gimsing S. Vestibular schwannomas: when to look for it? J Laryngol Otol. 2010;124:258-264. doi:

Obholzer RJ, Rea PA, Harcourt JP. Magnetic resonance imaging screening for vestibular schwannoma: analysis of published protocols. J Laryngol Otol. 2004;118:329-339. doi:

Celis-Aguilar E, Obeso-Pereda A, Castro-Bórquez A, Coutinho de Toledo H, Vega-Alarcón A, Nuñez-Millán B. Multiple audiometric analysis in the screening of vestibular schwannoma [poster]. In: American Neurotology Society; 2021. doi:


Download data is not yet available.