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The symptoms of acoustic neuromas often appear so gradually that a person does not recognize them or they become accustomed to them and may not seek medical attention until they become more severe. In fact, many of the small, asymptomatic acoustic neuromas are discovered incidentally when a person is being evaluated for another problem.

The symptoms of acoustic neuromas include:

• Hearing loss on one side (unilateral)
• Impaired speech discrimination
• Tinnitus (ringing in the ears)
• Vertigo
• Vestibular dysfunction (problems with balance)
• Facial nerve dysfunction
• Headache
• Difficulty swallowing

Small tumor symptoms typically include unilateral sensorineural hearing loss, some level of impaired speech discrimination, vertigo, and tinnitus. Additional symptoms noted with larger tumors may include trigeminal or facial nerve dysfunction, vestibular imbalance, and elevated intracranial pressure (with very large tumor). Symptoms continue to intensify with progressive growth of the tumor.

In a 1998 Members' Survey of the Acoustic Neuroma Association, reported symptoms prior to treatment were hearing loss (88%), imbalance (64%), tinnitus (64%), feeling of fullness in the ear (43%), headache (33%), facial numbness (22%), facial weakness (16%), facial twitching (13%) change in taste or smell (10%), and difficulty swallowing (7%). Many of these patients had large tumors. It is important to note, however, that data varies widely regarding the percentage of patients presenting with various symptoms at the time of diagnosis.

Hearing Loss

The most common symptom of acoustic neuroma is the gradual reduction of hearing in one ear, which occurs in up to 95% of patients. Hearing loss may occur with or without the presence of tinnitus (ringing or roaring sound in the ear). The hearing loss may be so subtle that it is often overlooked or is believed to be associated with the normal process of aging. The patient typically presents with a slowly progressive, high frequency, sensorineural hearing loss on the affected side but some patients (5-15%) experience a sudden or fluctuating hearing loss.

Unilateral hearing loss is such a hallmark symptom of acoustic neuromas that clinicians will often make a diagnosis of acoustic neuroma until proven otherwise. At the time of diagnosis of acoustic neuromas, only 3-5% of patients are thought to have full hearing capacity.

The hearing loss typically worsens over a period of many years and may eventually result in total deafness in the affected ear. If a person experiences a complete and sudden loss of hearing, it is often associated with a viral infection or vascular occlusion. Some patients may also experience both low and high frequency hearing loss. A small number of people may experience hearing loss in both ears. It is thought that hearing loss may actually initially develop 3-4 years before the diagnosis of acoustic neuroma is confirmed.

Impaired Speech Discrimination

Patients with acoustic neuroma may have a decreased ability to perceive and discriminate speech sounds (words), particularly sounds at higher frequencies. A person may complain of difficulty understanding someone speaking on the telephone even though they can hear them, locating where sounds are coming from, or understanding the speech of soft-spoken people or young children. Speech discrimination is affected disproportionately more than would be expected from the coexisting hearing loss. Problems with speech discrimination are not always present at diagnosis so that normal scores on tests of speech discrimination should not rule out a diagnosis of acoustic neuroma.