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Feature Article

Acoustic neuroma: an important cause of unilateral hearing loss

Melville da Cruz

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Abstract

Acoustic neuromas are uncommon and their presentations subtle, so a high degree of awareness is needed when evaluating patients with unilateral hearing loss or asymmetrical auditory symptoms. Referral to a centre specialising in the management of acoustic neuroma is required for all patients.

Key Points

  • Acoustic neuromas are benign, slow growing tumours arising from the eighth cranial nerve.
  • Acoustic neuromas present in the adult years with unilateral hearing loss and tinnitus accompanied by mild balance disturbance. A high degree of awareness is required in order to make an early diagnosis.
  • MRI scanning is highly sensitive and specific for acoustic tumours. Normal appearances of the inner ear and eighth cranial nerve on a well performed MRI scan can reliably exclude an acoustic neuroma in patients with suspicious symptoms.
  • For a patient with rapidly progressive symptoms and difficulty in obtaining a specialist referral for MRI scanning, a freely available contrast enhanced CT scan will reasonably exclude the presence of a large tumour with accompanying brainstem compression and hydrocephalus needing urgent treatment.
  • All patients with acoustic tumours should be referred to a centre specialising in the management of patients with such disorders. The best management option for each patient will depend on symptoms, the size and growth rate of the tumour, his or her age and any comorbidities.

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