title: Outcome of using magnetic resonance imaging as an initial screen to exclude vestibular schwannoma in patients presenting with unilateral tinnitus.
abstract: The improved cost-effectiveness of gadolinium-enhanced magnetic resonance imaging (MRIg) as a diagnostic tool for vestibular schwannoma has resulted in smaller tumours being diagnosed. There has been a change in the clinical presentation of these tumours and up to four per cent may present with unilateral tinnitus. The limitation of auditory brain stem response (ABR) as a screening tool that detects small tumours is recognized and there is a strong argument for using MRIg as the initial investigation. Various screening guidelines have been proposed, some include submitting patients with unilateral tinnitus for MRIg. This report describes the findings in a group of 174 patients presenting with unilateral tinnitus who underwent MRIg as part of a guideline-directed screen to exclude vestibular schwannoma. Five patients had a cause for their tinnitus diagnosed, one a vestibular schwannoma. Two had intracranial aneurysms and another three had pathology revealed that merited onward referral. A further nine patients had incidental findings that neither accounted for their symptoms nor needed further investigation or referral. The rationale for screening these patients with MRIg is discussed.
authors.affiliation: Department of Otolaryngology, Sunderland Royal Infirmary, Tyne and Wear, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Dawes
authors.forename: H E
authors.initials: HE
authors.lastname: Basiouny
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000175:diagnosis*; D018579:Patient Selection; D011237:Predictive Value of Tests; D014012:Tinnitus / Q000209:etiology*