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

Published online by Cambridge University Press:  10 September 2018

Y Abbas ,
G Smith  and
A Trinidade
Y Abbas
Affiliation:
Department of Otolaryngology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
G Smith
Affiliation:
Department of Audiology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
A Trinidade*
Affiliation:
Department of Otolaryngology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
*
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
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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.

Keywords

AudiologyMass ScreeningNeuroma, AcousticCosts and Cost AnalysisTinnitus
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 9 , September 2018 , pp. 786 - 789
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

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

References

1Rajeev, M, Babur, S, Karakitsou, M, Mehta, S. Audit of magnetic resonance imaging for vestibular schwannoma. Clin Otolaryngol 2012;37(suppl 1):63Google Scholar
2Nash, R, Majithia, A, Singh, A. The agreement between protocols for the investigation of asymmetrical audiovestibular symptoms. J Int Adv Otol 2016;12:98–100Google Scholar
3Obholzer, RJ, Rea, PA, Harcourt, JP. Magnetic resonance imaging screening for vestibular schwannoma: analysis of published protocols. J Laryngol Otol 2004;11:329–32Google Scholar
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;126:658–62Google Scholar
5Puls, T. Incidental findings of a vestibular schwannoma on brain MRI. B-ENT 2015;11:309–12Google Scholar
6Choi, KJ, Sajisevi, MB, Kahmke, RR, Kaylie, DM. Incidence of retrocochlear pathology found on MRI in patients with non-pulsatile tinnitus. Otol Neurotol 2015;36:1730–4Google Scholar
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;130:21–4Google Scholar
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;80:49–56Google Scholar
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;32:248–54Google Scholar
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]Google Scholar
11Dawes, P, Jeannon, J. Audit of regional screening guidelines for vestibular schwannoma. J Laryngol Otol 1998;112:860–4Google Scholar
12Sheppard, I, Milford, C, Anslow, P. MRI in the detection of acoustic neuromas – a suggested protocol for screening. Clinl Otolaryngol 1996;21:301–4Google Scholar
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;119:364–9Google Scholar
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, 1–154Google Scholar