The incidence of symptoms consistent with cerebellopontine angle lesions in a general ENT out-patient clinic

Abstract

To quantify the potential burden for screening for cerebellopontine angle lesions, all adult new patients attending the ENT outpatient department of a district general hospital were documented to see if their presenting symptom(s) could be consistent with the presence of a cerebellopontine angle lesion. Of the patients, 19.7 per cent were found to be potential candidates for screening. A 15 decibel asymmetry at one frequency was found in 11.8 per cent of patients. The burden of screening with a variety of audiological and symptomatic protocols was quantified. Effective age limits to reduce the burden for screening were found to be either 65 or 75 years of age. With such a large potential pool of patients for further investigation, the results of this study could be used to suggest protocols which are likely to produce a load of cases, which matches local resources for screening.

Vestibular schwannoma screening: closing the audit loop

“…It is not possible to explain this increase but in uencing factors may have been the long-term nature of the audit and the attaching of a reminder of the request indicators to the MRI request form; both of which would highlight the selection of individuals for screening. Harcourt et al 9 have estimated that, depending upon the criteria set for audiometric asymmetry, between 14 and 40 per cent of patients presenting with asymmetric audiovestibular symptoms will be classi ed as having unilateral tinnitus. Extrapolating from their graphs, when a 15 dB asymmetry at two adjacent frequencies is the criterion for asymmetry, 30 per cent of patients would be classed as having unilateral tinnitus when sent for screening.…”

Screening patients with sensorineural hearing loss for vestibular schwannoma using a Bayesian classifier

“…The majority of patients with a vestibular schwannoma present with asymmetrical sensorineural hearing loss, 3 but in terms of the overall number of otolaryngology consultations for the evaluation of audiovestibular symptoms, this diagnosis remains an uncommon cause of a very common presentation. Indeed, as many as one in five of all patients presenting to general ENT clinics have symptoms which could be considered compatible with the diagnosis of vestibular schwannoma 4 . This presents the otolaryngologist with the difficult diagnostic and medico‐legal conundrum of deciding which of the many patients evaluated for audiovestibular symptoms are at higher risk of harbouring a vestibular schwannoma, and should be further investigated with MRI.…”

“…Indeed, as many as one in five of all patients presenting to general ENT clinics have symptoms which could be considered compatible with the diagnosis of vestibular schwannoma. 4 This presents the otolaryngologist with the difficult diagnostic and medicolegal conundrum of deciding which of the many patients evaluated for audiovestibular symptoms are at higher risk of harbouring a vestibular schwannoma, and should be further investigated with MRI. The need for careful patient selection arises from the fact that MR does not at this time lend itself to indiscriminate screening of large numbers of patients, and furthermore, vestibular schwannoma as a condition does not fulfil the World Health Organization criteria for population level screening.…”

Role of MRI in audio-vestibular dysfunction; is it cost-effective?

“…9 According to Vanderveldea and Connor, MRI is "specifically focused on excluding treatable compressive abnormality of the cerebellopontine angle as a rare cause of audiovestibular dysfunction". 2 Referral of patients with audiovestibular symptoms for MRI is a relatively frequent practice at out institution.…”