Hearing preservation in acoustic neurinoma surgery.

The chances of hearing conservation in patients with acoustic neurinoma increases by early diagnosis of small tumors. An early diagnosis of an acoustic neurinoma is achieved through the application of a minimal diagnostic test battery to evaluate unilateral otological complaints such as tinnitus, sensorineural hearing loss and balance disturbances. This minimal evaluation comprises puretone audiometry and ABR. Patients showing abnormal findings should be pursued with imaging evaluation such as MRI with gadolinium contrast. The choice of surgical approach for removal of an acoustic neurinoma (transtemporal, translabyrinthine or suboccipital) will depend on the size of the tumor and the patients' hearing. The possibilities should be discussed with the patients. Postponing the surgical intervention due to the possibility of facial paralysis or loss of hearing is difficult to rationalise. During the last 15 years, the development in diagnostic and surgical techniques has made it possible to conserve hearing during surgery at least in some patients suffering from acoustic neurinoma. Early diagnosis of small tumors increases the chances to conserve hearing. Therefore, all nonspecific early otologic symptoms should be thoroughly evaluated to exclude the presence of an acoustic neurinoma. Acoustic neurinomas usually arise within the internal auditory meatus and grow further into the posterior cranial fossa. The first symptoms usually are hearing loss, tinnitus and balance disturbance. These symptoms can occur in combination or individually. Accordingly, all cases presenting with one or all of these symptoms in the absence of an obvious etiology, such as posttraumatic hearing loss, require the exclusion of an acoustic neurinoma.(ABSTRACT TRUNCATED AT 250 WORDS)