Magnetic resonance imaging (MRI) of the internal auditory meatus (IAM) is the most common imaging requested for patients with audiovestibular symptoms to exclude a vestibular schwannoma.Reference Saxby, Koumpa, Mohamed and Singh1 The UK's National Institute for Health and Care Excellence (NICE) has recently produced guidelines recommending criteria for requesting MRI of the IAM (e.g. if there is an asymmetry on pure tone audiometry of 15 dB or more at any two adjacent test frequencies, using test frequencies of 0.5, 1, 2, 4 and 8 kHz; and if there are localising signs irrespective of audiogram results).2 In a study in this month's issue of The Journal of Laryngology & Otology, a retrospective analysis of 1300 MRI scans of the IAM over two years was conducted and the findings were compared against NICE guidelines.Reference Perera, Janjua, Swaminathan, Apthorp and Al-Deerawi3 The detection rate of new vestibular schwannomas was 1.23 per cent, comparable to previously published studies.Reference Basu, Youngs and Mitchell-Innes4,Reference Gair, Borsetto, Donnelly, Axon, Bance and Tysome5 In support of the use of the NICE guidelines, all positive cases of vestibular schwannoma fit the NICE guidelines criteria; three of these could have been missed using other criteria. In addition, of the imaging requests that did not meet the NICE guidelines criteria, 281 revealed no positive results. In a related article in this month's issue, initial tumour size and balance symptoms were identified as potential predictors of whether or not a vestibular schwannoma will grow.Reference Dardis, Donghun and Kontorinis6
The presentation of unilateral nasal polyps traditionally necessitates histological evaluation for a neoplasm.Reference Diamantopoulos, Jones and Lowe7,Reference Lund, Stammberger, Nicolai, Castelnuovo, Beal and Beham8 A study by Edafe et al. in this month's issue sought to determine the rates of significant pathology in patients presenting with benign-appearing unilateral nasal polyps.Reference Edafe, Weight, Morsy and Mirza9 A total of 77 patients were included over a 13-year period. Of the cases, 2.6 per cent were found to be malignant, thereby supporting routine histological assessment for patients presenting with benign-appearing unilateral nasal polyps.
Finally, there has been an increase in the utilisation of office-based procedures in laryngology and head and neck cancer in recent years. A systematic review by Lim et al. supports the practice of biopsying head and neck tumours.Reference Lim, Rogers, Owusu-Ayim, Ranjan, Manickavasagam and Montgomery10 The findings revealed in-office biopsies to be safe and well tolerated. Furthermore, they helped certain patients avoid a general anaesthetic, significantly reduced time-to-diagnosis and time-to-treatment initiation, had high rates of sensitivity and specificity, and are likely to be cost-saving compared with operating theatre biopsies.
