Innovations in Acoustic Neuroma Screening

Objective: To redesign an acoustic neuroma screening service that improves patient experience.

Design: To allow audiologists to directly refer for MRI IAMs based on strict criteria. Doctors' request forms were redesigned to allow the request of a standardized scanning protocol (T2 CISS axial) with or without an additional brain scan. A standardized template report was used for normal scans. Letters were used to relay normal results to patients.

Patients/Materials and Methods: Patient demographics, presenting symptoms, referral source, laterality, and imaging results were collected for all new adult referrals for MRI IAMs prospectively over 1 year using a dedicated request form. The number and results of any brain sequences performed were logged. A comparison was made with the speed of the service previously.

Results: A total of 689 patients were scanned. One widened vestibular aqueduct and 14 acoustic neuromas were identified (2.03%). Of 61 patients (8.85%) who made audiology requests, 1 had acoustic neuroma. Unrelated abnormalities were picked up in 12 patients. Additional brain scans reduced from 70 (10.2%) in 2009 to 49 (7.11%) in 2010. The number of scan sequences was reduced, shortening the scanning time. Clinician protocol-led scans saved a week's wait. Average time from request to scan was 4 weeks and to report was 7 days. Anecdotal reporting time was shortened by the template report.

Conclusions: Our diagnostic yield is in line with national data. Direct management of these patients by the audiologist avoids the need for an ENT clinic appointment, which can then be used by other patients.