Background:
Vestibular schwannoma (VS) is a benign tumour affecting hearing. Obholzer et al 2004 published audiogram criteria for MRI internal acoustic meatus (IAM) to screen for VS.1
 
Method:
All MRI IAMs performed over a two-month period were reviewed. Audiograms of those requested for new VS were assessed using the Obholzer criteria. The audit was repeated after departmental teaching.
 
Results:
144 MRIs were performed to screen for VS, of which 3 (2%) showed a new tumour. In the second cycle, 102 scans were performed with no new tumours. 44% of audiograms met criteria in the first cycle, 47% in the second. The proportion of negative results communicated by letter went from 28% to 49%.
 
Conclusions:
Following education, clinicians restricted use of MRI, and communicated more results by post, saving clinic time. Use of the Obholzer criteria increased. However, Obholzer is not the only MRI criteria proposed, and it seems doctors may feel responsible for ‘ruling out’ VS in all patients with asymmetrical sensorineural hearing loss. Stewardship of limited resources is a significant challenge in today’s NHS.

Should the Obholzer criteria be widely adopted to screen for vestibular schwannoma? A two-cycle audit in a tertiary ENT department