Speech audiometry in acoustic neuroma

The importance of speech audiometry in cases of sensori-neural deafness has been stressed. Four cases have been described clearly elucidating this point. Speech audiometry is within the means of most practising otologists. The appropriate apparatus is not expensive, nor is the method excessively time-consuming. In acoustic neuroma the damage to the cochlear nerve fibres may produce very little reduction in the hearing threshold level for pure tones, but a disproportionately large reduction in the discrimination score, often when the tumour is large enough to be causing brain stem compression. The disproportion is an important indicator to the presence of retro-cochlear pathology, of which acoustic neuroma is the most likely cause, a diagnosis which must be considered in every case of unilateral sensori-neural deafness.