Skip to main content
×
×
Home

Audiologist-led screening of acoustic neuromas in patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus: our experience in 1126 patients

  • Y Abbas (a1), G Smith (a2) and A Trinidade (a1)
Abstract
Objective

To determine whether patients within an otolaryngology department presenting with asymmetrical sensorineural hearing loss and/or unilateral tinnitus can be safely and cost-efficiently screened for acoustic neuroma by audiologists as a first or only point of contact.

Methods

A prospective case series and cost analysis were conducted at a tertiary referral centre. Between April 2013 and March 2017, 1126 adult patients presented to the audiology department with asymmetrical sensorineural hearing loss and/or unilateral tinnitus. All were screened for acoustic neuroma with magnetic resonance imaging, based on pre-determined criteria. The main outcome measure was the presence of acoustic neuroma or other pathology on magnetic resonance imaging.

Results

Twenty-five patients (2.22 per cent) were found to have an acoustic neuroma (size range: 3–20 mm) and were referred to the otolaryngologist for further assessment. The remaining patients were appropriately managed and discharged by the audiologists without ENT input. This resulted in an overall cost saving of £164 850.

Conclusion

Patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus can be safely screened for acoustic neuroma and independently managed by audiologists as a first or only point of contact, resulting in considerable departmental cost savings.

Copyright
Corresponding author
Author for correspondence: Mr Aaron Trinidade, Otolaryngology Department, Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-on-Sea SS0 0RY, UK E-mail: aaron.trinidade@southend.nhs.uk Fax: +44 (0)1702 385 145
Footnotes
Hide All

Mr A Trinidade takes responsibility for the integrity of the content of the paper

Footnotes
References
Hide All
1Rajeev, M, Babur, S, Karakitsou, M, Mehta, S. Audit of magnetic resonance imaging for vestibular schwannoma. Clin Otolaryngol 2012;37(suppl 1):63
2Nash, R, Majithia, A, Singh, A. The agreement between protocols for the investigation of asymmetrical audiovestibular symptoms. J Int Adv Otol 2016;12:98100
3Obholzer, RJ, Rea, PA, Harcourt, JP. Magnetic resonance imaging screening for vestibular schwannoma: analysis of published protocols. J Laryngol Otol 2004;11:329–32
4Wong, BY, Capper, R. Incidence of vestibular schwannoma and incidental findings on the magnetic resonance imaging and computed tomography scans of patients from a direct referral audiology clinic. J Laryngol Otol 2012;126:658–62
5Puls, T. Incidental findings of a vestibular schwannoma on brain MRI. B-ENT 2015;11:309–12
6Choi, KJ, Sajisevi, MB, Kahmke, RR, Kaylie, DM. Incidence of retrocochlear pathology found on MRI in patients with non-pulsatile tinnitus. Otol Neurotol 2015;36:1730–4
7Pan, P, Huang, J, Morioka, C, Hathout, G, El-Saden, SM. Cost analysis of vestibular schwannoma screening with contrast-enhanced magnetic resonance imaging in patients with asymmetrical hearing loss. J Laryngol Otol 2016;130:21–4
8Kirchmann, M, Karnov, K, Hansen, S, Dethloff, T, Stangerup, SE, Caye-Thomasen, P. Ten-year follow-up on tumor growth and hearing in patients observed with an intracanalicular vestibular schwannoma. Neurosurgery 2017;80:4956
9Nouraei, 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;32:248–54
10British Academy of Audiology Guidelines for Referral to Audiology of Adults with Hearing Difficulty. In: http://www.baaudiology.org/files/3513/5898/2984/BAA_Direct_Referral_Criteria_0909_amended1.pdf [21 July 2017]
11Dawes, P, Jeannon, J. Audit of regional screening guidelines for vestibular schwannoma. J Laryngol Otol 1998;112:860–4
12Sheppard, I, Milford, C, Anslow, P. MRI in the detection of acoustic neuromas – a suggested protocol for screening. Clinl Otolaryngol 1996;21:301–4
13Daniels, RL, Shelton, C, Harnsberger, HR. Ultra high resolution nonenhanced fast spin echo magnetic resonance imaging: cost-effective screening for acoustic neuroma in patients with sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 1998;119:364–9
14Fortnum, H, O'Neill, C, Taylor, R, Lenthall, R, Nikolopoulos, T, Lightfoot, G et al. The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: a systematic review of clinical and cost effectiveness and natural history. Health Technol Assess 2009;13:iii–iv, ix–xi, 1154
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed