The early detection of the acoustic neurinomas. Otoneurological indications of the radiological investigation.

The diagnostic possibilities concerning the early diagnosis of an acoustic neurinoma are discussed. As it is very important to detect these tumors in the otological stage, we scrutinize the different symptoms and signs which can arise this suspicion and try to delineate the criteria for further investigation, which signifies the indications for the radiological investigation: tomography and cisternography. The survey of the results obtained during 1976 confirms the value of the rules we adopted. Every patient complaining of hearing loss or tinnitus has to be examined by audiometry. Every unilateral or asymmetrical perceptive deafness calls for an examination of the functional state of the vestibular system. A perceptive hearing loss with unilateral vestibular functional loss, is an indication for a radiological investigation of the MAI and here a tomography has to be preferred. If the tomography indicates an asymmetry corresponding with the functional loss, a cisternography is to be done. In the cases in which the functional loss goes together with normal radiography, we advise a close follow-up, repeating the functional evaluations at fixed intervals. In case of further deterioration, a control tomography and a cisternography is to be taken into consideration. The case with borderline data, or in which some opposition in the findings is recorded, the cases with negative cisternography and certainly the cases with a dubious cisternography are to be followed too. As on the one side a negative tomography can hide a tumor, and on the other hand a cisternography is a heavy decision for a dubious anomaly, we are inclined to insist more and more on a close functional follow-up rather than extend the indications for cisternography.