Acoustic Neuroma

Mr Jones had an MRI scan for unilateral tinnitus over the past 6 months. Explain the results and what will happen next.

Setting

  • WIPER  (wash hands, introduce yourself, permission, expose patient, reposition)
  • Ask if he is happy to see you
  • Introduce the Head and Neck Specialist Nurse
  • Ask if wants any family/friends present

Perception

  • Recap on past events – other ear or neurological symptoms? 
  • “Thank you for bringing me up to date.”

Invitation 

  • “Can I go over the results with you now?”
  • “Is there anybody else you would like to be present?”

Knowledge

  • Unfortunately it is not the news we were hoping for.
  • The scan shows that you have a benign tumour called an acoustic neuroma. PAUSE
  • Would you like me to explain the condition
    • It is a non cancerous tumour/growth of the brain. This means it doesn’t spread
    • In particular it grows on the nerve used for hearing and balance, which can cause problems such as hearing loss and unsteadiness.
    • This is why you are getting the symptoms you’ve been describing
  • Treatment options
    • Conservative –these are slow growing so we can keep you monitored with annual scans to see if it is getting better
    • For hearing – use hearing aids
    • Tinnitus – mainly distraction techniques, tinnitus counselling with audiology
    • Surgery – remove tumour – risks associated with this including losing hearing
    • Radiotherapy
  • Refer to skull base surgeon and discuss at MDT to see which is best option
  • Even with treatment, symptoms such as hearing loss and tinnitus can persist and affect your ability to work, communicate and/or drive. These problems may need additional treatment

Empathy

  • “I am sorry to have to give you this news today.”
  • “I can see this is a huge shock” Pause and wait

Strategy and Summary

  • Summarise findings
  • Offer audiology follow-up for tinnitus retraining or hearing aid for masking
  • Offer leaflet
  • Answer any questions

Summary

  • If dizzy need to stop driving as per DVLA (DVLA guidelines for acoustic neuroma)
  • Today we have talked about…. – Do you have any further questions?
  • Once again my name is…
  • Give secretary’s number

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