THERE is no doubt in my mind that microsurgical methods have a distinct advantage over older techniques; in fact, microsurgical methods have been one of the major factors which make it possible to save the facial nerve. We hope that with the aid of such methods and very early diagnosis, we may also be able to save the cochlear branch. I do not think this will be possible in every case, since about 40% of acoustic neuromas originally start on the cochlear branch; moreover, unfortunately, a few patients experience no symptoms until the tumor becomes rather large.
The first step in examination for acoustic neuroma is the taking of the history. The most common symptoms are tinnitus, loss of hearing, and imbalance. The patient might also have abnormal taste sensation, numbness of the face, facial twitching, abnormal lacrimation, headache, or incoordination. Physical examination of the ears, nose, and throat and