ENT 2026

Unilateral tinnitus is a common otological presentation. Under current international and UK guidance, referral for MRI internal auditory meatus (IAM) imaging to exclude vestibular schwannoma (VS) is warranted in patients with isolated unilateral tinnitus, without other red-flag symptoms such as hearing loss. Despite this widespread practice, the true diagnostic yield of MRI IAM in this population is poorly characterised, and the resulting scanner burden is especially significant in health systems where MRI access is limited. The aim of this study was to evaluate the diagnostic yield of MRI IAM in patients with isolated unilateral tinnitus without asymmetrical hearing loss, Methods: A retrospective audit was conducted for all MRI IAM at a large UK district general hospital over five years, from 1 March 2021 to 1 March 2026). Patients with isolated unilateral tinnitus without asymmetrical hearing loss were included; those meeting criteria for other red-flag signs or symptoms were excluded, Results: Of 10,638 MRI IAM requests over the study period, 1,046 (9.8%) met inclusion criteria. Mean age was 55.2 years (range 12–89), with 45.3% aged 50–69 years. Only one patient (0.1%) had a positive finding — a small (0.3 × 0.2 cm) intracanalicular vestibular schwannoma, managed conservatively given its size. The remaining 1,045 patients (99.9%) had no evidence of vestibular schwannoma, Conclusion: MRI IAM has a low diagnostic yield in isolated unilateral tinnitus without asymmetrical hearing loss. This study also questions the routine use of MRI IAM in these patients.

Dr. Owen Chu is a medical professional affiliated with University Hospitals Plymouth in the United Kingdom. He is engaged in clinical practice and healthcare activities within the NHS setting and has an interest in contributing to professional and academic discussions in medicine, Through his professional work, Dr. Chu contributes to patient care and the wider healthcare community. His participation in scientific conferences provides an opportunity to share clinical experiences, exchange knowledge with fellow healthcare professionals, and engage in discussions on developments in contemporary medical practice, Dr. Chu is affiliated with University Hospitals Plymouth NHS Trust, serving the population of Plymouth and surrounding areas in Devon, UK.