Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-24T23:12:02.575Z Has data issue: false hasContentIssue false

Incidence of vestibular schwannoma and incidental findings on the magnetic resonance imaging and computed tomography scans of patients from a direct referral audiology clinic

Published online by Cambridge University Press:  14 May 2012

B Y W Wong*
Affiliation:
Department of Ear, Nose and Throat, Doncaster Royal Infirmary, UK
R Capper
Affiliation:
Department of Ear, Nose and Throat, Doncaster Royal Infirmary, UK
*
Address for correspondence: Mr B Y W Wong, Department of ENT Surgery, Doncaster Royal Infirmary, Armthorpe Road, Doncaster DN2 5LT, UK Fax: +44 (0)1302 318 323 E-mail: [email protected]

Abstract

Objective:

To identify the incidence of vestibular schwannoma amongst patients referred from a direct referral audiology clinic, and also the number of incidental findings, as seen on magnetic resonance imaging or computed tomography scans.

Method:

Prospective data collection for patients referred from a direct referral audiology clinic due to audiological evidence of asymmetrical hearing loss. The audiograms, magnetic resonance imaging and computed tomography scans of patients with diagnosed vestibular schwannoma were subsequently reviewed.

Results:

A total of 4100 patients were seen during the study period, with 396 scans performed. Six (1.5 per cent) patients had vestibular schwannoma, while 12 (3 per cent) had significant incidental findings.

Conclusion:

Patients referred from the direct referral audiology clinic had a low incidence of vestibular schwannoma detection. Their detection rate for significant incidental findings was similar to previous reports. If the current protocol had not been in place, over 300 patients would have been needlessly added to the ENT clinic list. Thus, general practitioner referral to direct referral audiology clinics provides a cost-effective way of managing asymmetrical sensorineural hearing loss in older patients. The number of such clinics could be expanded.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2012

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

Presented as a poster at the British Society of Neuro-otology Annual Meeting, 14 October 2011, London, UK

References

1Eley, KA, Fitzgerald, JE. Quality improvement in action. Direct general practitioner referrals to audiology for the provision of hearing aids: a single centre review. Quality in Primary Care 2010;18:201–6Google ScholarPubMed
2Stangerup, SE, Tos, M, Thomsen, J, Caye-Thomasen, P. True incidence of vestibular schwannoma? Neurosurgery 2010;67:1335–40CrossRefGoogle ScholarPubMed
3Howitz, MF, Johansen, C, Tos, M, Charabi, S, Olsen, JH. Incidence of vestibular schwannoma in Denmark, 1977–1995. Am J Otol 2000;21:690–4Google ScholarPubMed
4Harcourt, JP, Vijaya-Sekaran, S, Loney, E, Lennox, P. The incidence of symptoms consistent with cerebello-pontine angle lesions in general ENT out-patient clinics. J Laryngol Otol 1999;113:518–22CrossRefGoogle Scholar
5Obholzer, RJ, Harcourt, JP. Magnetic resonance imaging screening for vestibular schwannoma: analysis of published protocols. J Laryngol Otol 2004;118:329–32CrossRefGoogle ScholarPubMed
6Fisher, EW, Parikh, AA, Harcourt, JP, Wright, A. The burden of screening for acoustic neuroma: asymmetric ontological symptoms in the ENT clinic. Clin Otolaryngol 1994;19:1921CrossRefGoogle Scholar
7Lutman, ME, Coles, RRA. Asymmetric sensorineural hearing thresholds in non-noise-exposed UK populations: a retrospective analysis. Clin Otolaryngol 2009;34:316–21CrossRefGoogle ScholarPubMed
8Saliba, I, Martineau, G, Chagnon, M. Asymmetric hearing loss: rule 3,000 for screening vestibular schwannoma. Otol Neurotol 2009;30:515–21CrossRefGoogle Scholar
9Dawes, PJ, Jeannon, JP. Audit of regional screening guidelines for vestibular schwannoma. J Laryngol Otol 1998;112:860–4CrossRefGoogle ScholarPubMed
10Sheppard, IJ, Milford, CAM, Anslow, P. MRI in the detection of acoustic neuromas – a suggested protocol for screening. Clin Otolaryngol 1996;21:301–4CrossRefGoogle ScholarPubMed
11Mangham, CA. Hearing threshold difference between ears and the risk of acoustic tumour. Otolaryngol Head Neck Surg 1991;105:815–17CrossRefGoogle Scholar
12Welling, DB, Glasscock, MR, Woods, CI, Jackson, CG. Acoustic neuroma: a cost-effective approach. Otolaryngol Head Neck Surg 1990;103:364–70CrossRefGoogle ScholarPubMed
13Dawes, PJD. Audit vestibular schwannoma screening: closing the audit loop. J Laryngol Otol 2001;115:719–22CrossRefGoogle ScholarPubMed
14Mahrous, AK, Kalepu, R. Positive findings on MRI in patients with asymmetrical SNHL. Eur Arch Otorhinolaryngol 2008;265:1471–5CrossRefGoogle ScholarPubMed
15Donnelly, MJ, Cass, AD, Ryan, L. False positive MRI in the diagnosis of small intracanalicular vestibular schwannomas. J Laryngol Otol 1994;108:986–8CrossRefGoogle ScholarPubMed
16Yoshimoto, U. Systematic review of the natural history of vestibular schwannoma. J Neurosurg 2005;103:5963CrossRefGoogle ScholarPubMed
17Swan, IRC, Browning, GG. A prospective evaluation of direct referral to audiology departments for hearing aids. J Laryngol Otol 1994;108;120–4CrossRefGoogle ScholarPubMed
18Chisholm, EJ, Savy, L, Geyer, M, Choa, D. Magnetic resonance imaging scans for vestibulocochlear nerve tumours: what is actually found? J Laryngol Otol 2006;120:1019–22CrossRefGoogle Scholar
19Papanikolaou, V, Khan, MH, Keogh, I. Incidental findings on MRI scans of patients presenting with audiovestibular symptoms. BMC Ear Nose Throat Disorders 2010;10:6CrossRefGoogle ScholarPubMed
20Mirza, S, Malik, TH, Ahmed, A, Willatt, DJ, Hughes, DG. Incidental findings on magnetic resonance imaging screening for cerebellopontine angle tumours. J Laryngol Otol 2000;114:750–4CrossRefGoogle ScholarPubMed
21Morris, Z, Whiteley, WN, Longstreth, WT, Weber, F, Lee, YC, Tsushima, Y et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2009;339:547–50CrossRefGoogle ScholarPubMed