Should all patients referred for magnetic resonance imaging scans of their internal auditory meatus be followed up in ENT clinics?

Magnetic resonance imaging (MRI) is recognised as the "Gold Standard" investigation for symptoms pertaining to the inner ear and detection of retro-cochlear pathology. There is still no accurate clinical predictor for cerebellopontine angle lesions and increasingly more normal scans are being performed. With constantly increasing demands on ENT outpatient clinics, our aim was to investigate whether all patients referred for MRI of their internal auditory meatus (IAM) require follow-up in ENT clinics. A retrospective study was carried out in a tertiary referral centre referring patients for MRI IAM from ENT clinics and neurotology clinics on 153 patients referred for MRI IAM performed over a 4-month period. The MRI reports and the case notes of the patients were reviewed. MRI results and patient symptoms with patient follow-up schedule and follow-up situation for at least 6 months post-scan were compared. There were two patient groups, those referred from main outpatients (81) and those referred by the audiological physicians (72). Of the total number of scans, 101 were reported as normal, 45 had incidental findings, and 7 showed pathology of the cerebellopontine angle. The presenting complaints of the patients, the scan results and the follow-up since were compared. Six months later 63% of those referred from outpatients were no longer being followed up in clinic. We suggest that 56.8% of patients referred for MRI IAM do not require ENT follow-up. Their symptoms and concerns could be dealt with at the first consultation where onward referral could be made if necessary. Once checked by the requesting clinician, uncomplicated scan results could be sent to the patients and general practitioners by post or email. This would reduce the burden on general otolaryngology outpatient clinics and improve resource utilisation.

Delayed presentation of a swallowed partial denture.

We report a unique case of a young patient who accidentally swallowed his partial denture and alarmingly only presented to our ear, nose and throat (ENT) department 4 weeks later despite several previous presentations to primary and secondary care. The partial denture was successfully removed under general anaesthetic using direct laryngoscopy following admission. He was discharged on a normal diet 6 days later after oesophageal perforation was excluded using a contrast swallow.