The changing landscape of vestibular schwannoma diagnosis and management: A cross-sectional study

Khodayar Goshtasbi; Mehdi Abouzari; Omid Moshtaghi; Ronald Sahyouni; Autefeh Sajjadi; Harrison W Lin; Hamid R Djalilian

doi:10.1002/lary.27950

The changing landscape of vestibular schwannoma diagnosis and management: A cross-sectional study

Laryngoscope. 2020 Feb;130(2):482-486. doi: 10.1002/lary.27950. Epub 2019 Apr 5.

Authors

Khodayar Goshtasbi¹, Mehdi Abouzari¹, Omid Moshtaghi¹, Ronald Sahyouni^{1

2}, Autefeh Sajjadi¹, Harrison W Lin¹, Hamid R Djalilian^{1

2}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A.
² Department of Biomedical Engineering, University of California, Irvine, Irvine, California, U.S.A.

Abstract

Objectives: To assess the current state of the diagnosis and management of vestibular schwannoma (VS) as well as treatment trends, and to evaluate the role of treatment setting and various specialists in treatment plan.

Methods: Patients diagnosed with VS completed a voluntary and anonymous survey. The questionnaires were distributed through Acoustic Neuroma Association website, Facebook page, and e-mail newsletters from January to March 2017.

Results: In total, 789 VS patients completed the survey. Of those, 414 (52%) underwent surgery; 224 (28%) underwent radiotherapy; and 121 (15%) were observed. General otolaryngologists diagnosed 62% of responders, followed by primary care (11%) and neurotologists (10%). Patients who underwent surgery were significantly younger and had larger tumors compared to those treated with radiation or observation. The ratio of patients having nonsurgical versus surgical resection changed from 1:2 to 1:1 for the periods of 1979 through 2006 versus 2007 through 2017, respectively. Neurosurgeons (40%) and neurotologists (38%) were the most influential in treatment discussion. Neurotologists (P < 0.001) and general otolaryngologists (P = 0.04) were more influential than neurosurgeons for the decision process in patients with smaller tumors. Patients treated at academic versus nonacademic private institutions reported similar tumor sizes (P = 0.27), treatment decisions (P = 0.09), and decision satisfaction (P = 0.78).

Conclusion: There is a continuing trend toward nonsurgical management, with approximately half of the patients opting for nonsurgical management. In this cohort, the patients commonly presented with otologic symptoms and otolaryngologists made the most diagnoses. Neurotologists and neurosurgeons were the most influential in treatment discussion.

Level of evidence: NA Laryngoscope, 130:482-486, 2020.

Keywords: Vestibular schwannoma; acoustic neuroma; decision satisfaction; influential specialist; treatment trend.

MeSH terms

Cross-Sectional Studies
Decision Making
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Neuroma, Acoustic / diagnosis*
Neuroma, Acoustic / therapy*
Patient Satisfaction
Practice Patterns, Physicians' / statistics & numerical data*
Surveys and Questionnaires

Abstract

MeSH terms

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