MRI screening for vestibular schwannoma in Wigan (UK)

Abstract

Introduction: Acoustic neuromas are benign tumours which arise from Schwann cells of the vestibulocochlear nerve. Our guidelines recommend scanning if there is clinical evidence of sudden sensorineural hearing loss, unilateral tinnitus, fluctuating hearing loss, cerebellar or neurological signs or Meniere's disease. It also recommends scanning for patients with asymmetrical cochlear symptoms with normal pure tone audiogram or asymmetrical hearing loss judged as appropriate by air or bone conduction, of 40dB or more at two or 45 dB or more a three adjacent frequencies.Methods: To determine the diagnostic accuracy for this department we reviewed the records and MRI scans for all the patients with suspected acoustic neuroma over 1 year. All 446 scans in 2011 were reviewed retrospectively along with their case records and audiograms. The information was analysed against the local otolaryngology MRI guidelines.Results: 31 patients were found to have an acoustic neuroma. Of the patients who had normal findings on MRI, only 5% did not fit the guidelinesFollowing our review of the 449 patients, 75% had sudden sensorineural hearing loss, 54% had unilateral tinnitus, 0.5% had fluctuating hearing loss, 8% had imbalance, 8% had vertigo, 8% were dizzy, 3% had persistent headache, 2% had cranial nerve palsies, 2% had Menieres disease and 63% had an abnormal audiogram.Conclusion: It was concluded that our department had a 95% adherence rate to our current local guidelines. Compared to the literature we have a comparable rate of incidence of acoustic neuromas. We would therefore encourage that all departments have similar local guidelines to ensure that patients are managed appropriatelyUnterstützt durch: Wigan, Wrightington and Leigh Health Foundation TrustDer Erstautor gibt keinen Interessenkonflikt an