Otosclerosis masking coexistent acoustic neuroma

The coexistence of an acoustic neuroma with otosclerosis can prove to be a great diagnostic dilemma. In such cases, the diagnosis of acoustic neuroma is usually delayed while more common causes of sensorineural hearing loss associated with otosclerosis or its surgery are considered. Any asymmetric progression of a sensorineural loss or shift in discrimination after stapes surgery, whether sudden or gradual, should provoke suspicion of a second pathologic process. These include perilymph fistula, labyrinthine otosclerosis or ischemia, and acoustic neuroma. The use of auditory brainstem response and acoustic reflex testing and various imaging techniques is essential for accurate diagnosis. This paper includes two cases that demonstrate this dual pathology, bringing the total to 15 such cases reported in the literature. The purposes of this paper are to alert the clinician to the diagnostic problem of acoustic neuroma coexisting with otosclerosis and to propose a means of evaluating these patients.