Diagnosis

3 Diagnosis

Clinical Investigations

Clinical Report and Follow-Up

Neuroradiological Studies

Advanced Computer-Animated Examinations

Clinical Investigations

Although patients suffering from acoustic neurinoma may present with a variety of symptoms, the classical ones are hearing loss (ca. 95% of cases), tinnitus (ca. 70%) and disequilibrium (ca. 65%) (Table 3.1). Apart from the clinical symptoms, clinical signs of the tumor are not particularly common. The most typical clinical signs are an abnormal corneal reflex (ca. 30% of cases), nystagmus (ca. 25%) and facial hypesthesia (ca. 25%). With current imaging modalities (particularly high-resolution magnetic resonance imaging), increasing numbers of very small lesions can be detected at an early stage, so that the number of real clinical signs observed is likely to decrease as imaging capabilities improve. The symptoms can occur in combination or separately, and they correlate closely to the tumor size. By the time of diagnosis, virtually all tumors have caused otologic symptoms relating to pressure on the eighth nerve complex.

Table 3.1 Clinical symptoms and signs.

	%
Clinical symptoms
Hearing loss	95
Tinnitus	70
Disequilibrium	65
Headache	32
Facial numbness	29
Facial weakness	10
Diplopia	10
Nausea vomiting	9
Otalgia	9
Change of taste	6
Clinical signs
Abnormal corneal reflex	35
Nystagmus	25
Facial hypesthesia	25
Facial weakness (palsy)	12
Abnormal eye movement	11
Papilledema	10
Babinski sign	5