Magnetic resonance imaging is the ‘gold standard’ for screening patients suspected to have an acoustic neuroma. However, inappropriate referrals for imaging are not helpful, especially with the growing need to reduce costs. In this study the authors compared two audit cycles of MRI referrals: one retrospective and another after implementation of a protocol based on 2018 NICE guidelines. In the 46 patients referred for MRI before implementation of the protocol, only 65% were appropriate and three were diagnosed with an acoustic neuroma. In the second cycle, the NICE guidelines protocol for MRI referral was implemented. This was an asymmetrical SNHL of 15dB or more in two frequencies between 0.5 to 8kHz, unilateral tinnitus or vertiginous symptoms. The second audit cycle produced 81% appropriate referrals, with those for hearing loss reduced but increased for tinnitus. Out of 112 referrals in this cycle, four had acoustic neuromas. The cost of dealing with more patients in the second cycle did not follow linearly the cost in the previous cycle. The authors contend that these criteria are simpler than those published in various studies. It reduced the inappropriate use of resources from 34.8% to 18.8%. Follow-up appointments were made for negative results but avoiding these could have reduced hospital costs further as per the practice in many clinics these days.