Pitfalls in the diagnosis of acoustic neuroma

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Abstract
The patient with an acoustic neuroma may present to the otologist a variety of clinical features. Classically these include a retrocochlear pattern of sensorineural hearing loss, reduced vestibular response on caloric testing and radiological asymmetry of the internal auditory canals (IAC). The absence of any or all of these features, does not exclude the presence of tumor. Five cases are presented to illustrate the potential for diagnostic delay unless a routine battery of investigations is undertaken in patients with neurootological disorders. All patterns of subjective audiometry are encountered, auditory brain stem response testing may be unreliable where hearing loss is profound, vestibular testing is normal in half of small tumors and the intracanalicular tumor may be radiologically undetectable unless IAC meatography is employed.

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