Abstract
The clinical picture of the acoustic neuroma is discussed with particular reference to the early symptoms based on the perusal of the case notes of more than 200 patients in whom the diagnosis was confirmed surgically.
Of the patients 67% were female and in 57% of all patients the ages were in the 41-60 year range. The gradual loss of vestibular function in these patients is seldom accompanied by severe vertigo, only 1.5% of them had attacks resembling Meniere's disease, and the clinical differentiation between the two conditions is usually so clear that routine straight x-rays of the petrous bones in all cases with vertigo are difficult to justify. The duration of the symptoms is not a sure guide to the size of the tumour, a third of the patients with large tumours had symptoms for less than 3 years.
One of the controversial topics related to the acoustic neuroma is the prognosis of the untreated patient. An analysis of the case histories of some of these patients has been conducted with the view of shedding light on this and some other problems in relation to this tumour. When the patient appears first with neurological signs of an obvious angle lesion, growth, most authorities would agree, is likely to continue rapidly enough in a sufficient number of cases to render removal advisable. When the signs are confined largely to the 8th nerve, the indications for operation are less secure.