Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-17T19:18:00.826Z Has data issue: false hasContentIssue false
  • English
  • Français

The use of magnetic resonance imaging in the investigation of patients with unilateral non-pulsatile tinnitus without asymmetrical hearing loss

Published online by Cambridge University Press:  24 June 2021

C Saxby ,
F Koumpa ,
S Mohamed  and
A Singh
C Saxby*
Affiliation:
ENT Department, Northwick Park Hospital, London, UK
F Koumpa
Affiliation:
ENT Department, Northwick Park Hospital, London, UK
S Mohamed
Affiliation:
ENT Department, Northwick Park Hospital, London, UK
A Singh
Affiliation:
ENT Department, Northwick Park Hospital, London, UK
*
Author for correspondence: Ms Clair Saxby, ENT Department, Northwick Park Hospital, Harrow HA1 3UJ, London, UK E-mail: clair.saxby@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Tinnitus is a common condition presenting to the ENT out-patient clinic. Vestibular schwannomas are benign cerebellopontine angle tumours that usually present with unilateral sensorineural hearing loss. Magnetic resonance imaging of the internal auditory meatus is the definitive investigation in their detection. The current recommendation is for unilateral tinnitus patients to undergo magnetic resonance imaging of the internal auditory meatus to exclude vestibular schwannoma.

Objective

To evaluate magnetic resonance imaging in the investigation of patients with unilateral non-pulsatile tinnitus without asymmetrical hearing loss.

Method

A retrospective case series was conducted of all patients who underwent magnetic resonance imaging of the internal auditory meatus to investigate unilateral non-pulsatile tinnitus without asymmetrical hearing loss, from 1 January 2014 to 1 January 2019.

Results

Of 2066 scans, 566 (27 per cent) were performed to investigate patients (335 female, 231 male) with unilateral non-pulsatile tinnitus without asymmetrical hearing loss. Three vestibular schwannomas were detected on imaging, and 134 incidental findings were discovered.

Conclusion

The detection rate of vestibular schwannoma in this group was just 0.3 per cent. This paper questions the utility of magnetic resonance imaging evaluation in these patients.

Keywords

TinnitusMagnetic Resonance ImagingAcoustic Neuroma
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 8 , August 2021 , pp. 680 - 683
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Ms C Saxby takes responsibility for the integrity of the content of the paper

References

BMJ Best Practice. Tinnitus. In: https://bestpractice.bmj.com/topics/en-gb/364 [13 August 2019]Google Scholar
Tyler, RS. Tinnitus Handbook of Medicine. San Diego: Singular Publishing Group, 2000Google Scholar
Yoshimoto, Y. Systematic review of the natural history of vestibular schwannoma. J Neurosurg 2005;103:59–63CrossRefGoogle ScholarPubMed
Ramsden, RT, Moffat, DA. Intracanalicular acoustic neuroma: the case for early surgery. Clin Otolaryngol 1994;19:1–2CrossRefGoogle ScholarPubMed
NICE. Tinnitus. In: https://cks.nice.org.uk/tinnitus [18 August 2019]Google Scholar
Wilson, JMG, Jungner, G. Public Health Papers 34: Principles and Practice of Screening for Disease. Geneva: WHO, 1968Google Scholar
Amiraraghi, N, Lim, S, Locke, R, Crowther, JA, Kontorinis, G. Findings on 7000 MRI of the IAM: to scan or not to scan? A retrospective cohort study. Clin Otolaryngol 2018;43:1607–10CrossRefGoogle ScholarPubMed
Nouraei, SAR, Huys, QJM, Chatrath, P, Powles, J, Harcourt, J. Screening patients with sensorineural hearing loss for vestibular schwannoma using a Bayesian classifier. Clin Otolaryngol 2007;32:248–54CrossRefGoogle ScholarPubMed
Obholzer, R, Rea, P, Harcourt, J. Magnetic resonance imaging screening for vestibular schwannoma: analysis of published protocols. J Laryngol Otol 2004;118:329–32CrossRefGoogle ScholarPubMed
Fortnum, 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, 1–154CrossRefGoogle ScholarPubMed
Sheppard, IJ, Milford, CAM, Anslow, P. MRI in the detection of acoustic neuromas - a suggested protocol for screening. Clin Otolaryngol Allied Sci 1996;21:301–4CrossRefGoogle ScholarPubMed
Dawes, PJD, Basiouny, HE. Outcome of using magnetic resonance imaging as an initial screen to exclude vestibular schwannoma in patients presenting with unilateral tinnitus. J Laryngol Otol 1999;113:818–22CrossRefGoogle ScholarPubMed
Robinette, K, Benscoter, B, Trenkle, G, Alapati, S, Jackson, N, Babu, S. Diagnostic yield of MRI of the brain and IAC in patients with neurotologic complaints. Am J Otolaryngol 2018;39:664–9CrossRefGoogle ScholarPubMed
Harcourt, J, Vijaya-Sekaran, S, Loney, E, Lennox, P. The incidence of symptoms consistent with cerebellopontine angle lesions in a general ENT out-patient clinic. J Laryngol Otol 1999;113:518–22CrossRefGoogle Scholar
Morrison, G, Sterkers, JM. Unusual presentations of acoustic tumours. Clin Otolaryngol Allied Sci 1996;21:80–3CrossRefGoogle ScholarPubMed
Lustig, LR, Rifkin, S, Jackler, RK, Pitts, LH. Acoustic neuromas presenting with normal or symmetrical hearing: factors associated with diagnosis and outcome. Am J Otol 1998;19:212–18Google ScholarPubMed
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;42:815–23CrossRefGoogle ScholarPubMed
Anderson, TD, Loevner, LA, Bigelow, DC. Mirza, N. Prevalence of unsuspected acoustic neuroma found by magnetic resonance imaging. Otolaryngol Head Neck Surg 2000;122:643–6CrossRefGoogle ScholarPubMed