Which imaging modalities are recommended for the diagnosis of vestibular schwannomas in primary care?

For the diagnosis of vestibular schwannomas, the primary recommended imaging modality is Magnetic Resonance Imaging (MRI) of the internal auditory meati (IAM) ².

• MRI of the internal auditory meati should be offered to adults presenting with hearing loss and localising symptoms or signs, such as facial nerve weakness, that may indicate a vestibular schwannoma or a cerebellopontine angle (CPA) lesion, irrespective of their pure tone thresholds ².
• MRI of the internal auditory meati can also be considered for adults who have sensorineural hearing loss but no localising signs, if there is an asymmetry on pure tone audiometry of 15 dB or more at any two adjacent test frequencies (using 0.5, 1, 2, 4, and 8 kHz) ².
• For individuals with non-pulsatile tinnitus who also have associated neurological, otological, or head and neck signs and symptoms, MRI of the internal auditory meati (IAM) should be offered ³. If MRI (IAM) is not feasible, contrast-enhanced CT (IAM) can be offered as an alternative ³.
• Furthermore, for people with unilateral or asymmetrical non-pulsatile tinnitus who do not have associated neurological, audiological, otological, or head and neck signs and symptoms, MRI (IAM) can be considered ³. If MRI (IAM) cannot be performed, contrast-enhanced CT (IAM) can be considered ³.