Clinical findings in patients with acoustic neurinoma

Herein we review the symptoms, physical findings, and test results in 131 patients with acoustic neurinoma. The earliest symptoms are unilateral hearing loss, tinnitus, and dysequilibrium. As the disease progresses, facial numbness, facial weakness, and headaches become more prominent. Physical findings other than hearing loss are uncommon; the most frequently observed are a decreased corneal reflex, nystagmus, and facial hypoesthesia. Routine audiometry provides objective information about the hearing loss. Some degree of asymmetry is found in the pure-tone tests. In addition, the speech discrimination scores are frequently lower than expected. Special audiometric tests should be performed on those patients with residual hearing; at the present time, acoustic reflex tests and the brainstem-evoked response yield the most information. Computed tomography with dye enhancement with or without the use of air contrast has become the most accurate roentgenographic test. Our goal is to identify acoustic neurinomas sufficiently early so that surgical removal is safe and leaves minimal deficit.