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Hear me out: rethinking internal auditory meatus magnetic resonance imaging in primary care. A cohort evaluation

Published online by Cambridge University Press:  20 August 2021

I M Sajid Open the ORCID record for I M Sajid [Opens in a new window]  and
K Frost
I M Sajid*
Affiliation:
NHS West London Clinical Commissioning Group, UK University of Global Health Equity, Rwanda
K Frost
Affiliation:
NHS Central London Clinical Commissioning Group, UK
*
Author for correspondence: Dr Imran Mohammed Sajid, West London Clinical Commissioning Group, 15 Marylebone Road, London NW1 5JD, UK E-mail: imransajid@nhs.net
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Abstract

Background

Imaging detects acoustic neuroma, a rare pathology associated with asymmetric sensorineural hearing loss and tinnitus, that is mostly managed conservatively. Scanning indication is debatable, without evaluation in primary care, despite the high burden of audiovestibular symptoms and commissioning of general practitioner imaging.

Method

Cohort evaluation of two years' internal auditory meatus magnetic resonance imaging in primary care.

Results

Of 200 scans requested by 77 general practitioners, only 33 per cent conformed to guideline indications. Most were referred to specialists, regardless of result. Only 10.5 per cent were appropriately imaged to rule out neuroma without specialist referral. One neuroma was detected (diagnostic yield 0.5 per cent) in a patient already referred. Incidental findings were shown in 44.5 per cent, triggering low-value cascades in 18 per cent. Whilst fewer than 1 in a 1000 imaged patients may improve through surgery, 1 in 5 can suffer negative imaging cascades.

Conclusion

Considering the bi-directional relationship between distress and audio-vestibular symptoms, anxiety-provoking imaging overuse should be minimised. In low-prevalence primary care, retrocochlear imaging could be limited to those with asymmetric sensorineural hearing loss. Alternatively, assessment and imaging could be shifted to audiologist-led settings, with a wider therapeutic offer, likely more beneficial and cost-effective than conventional surgical pathways.

Keywords

General PracticeNeuro-OtologyDiagnosisRadiologyOverdiagnosisMedical OveruseAcoustic NeuromaMRI Scans

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 1 , January 2022 , pp. 37 - 44
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr I M Sajid takes responsibility for the integrity of the content of the paper

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