About two out of 100 patients presenting with asymmetric hearing and unilateral tinnitus have acoustic neuroma. The traditional method in which these patients first attend a clinician and then undergo screening through an MRI, can be expensive and prolong the time taken for making a diagnosis. In the practice described in this publication, all patients under 75 years of age and fit for imaging, who had unilateral tinnitus or asymmetrical hearing loss or Meniere’s triad, underwent non-enhanced T2 weighted MRI screening. The referral for imaging was made directly by the audiologist if the audiogram showed a difference of 15dB or more in two or more consecutive frequencies from 0.5 to 4kHz. Acoustic neuroma was found in 27 out of 1126 patients (2.4%) and two had meningioma. This study did not use gadolinium contrast enhancement MRI for the screening. In four years, this practice saved the department about £165k. The prevalence of cerebello-pontine angle pathology matched with that published in literature. The study strongly supports that a well-planned practice such as this with a clear protocol can be as effective as traditional methods. The cost-saving value is particularly relevant in these difficult economic times for the NHS.