Relative value of diagnostic tests for small acoustic neuromas

Auditory brainstem response is now widely employed as a screening test for acoustic neuromas because it is equally sensitive when standardized against computed tomography. We have detected eight small (less than 10 mm) acoustic neuromas using gadolinium enhanced magnetic resonance imaging. In three of these cases, the auditory brainstem response was falsely negative. In contrast, 19 patients with larger tumors (greater than or equal to 10 mm) were found to have no false negative auditory brainstem responses. Auditory brainstem response appears to be less sensitive for detecting small, symptomatic acoustic neuromas.