Which of the following is most prominent symptom of acoustic neuroma?
Ans:. (c) Sensorineural hearing lossRef Dhingras ENT. 5th ed. /124ACOUSTIC NEUROMA* Acoustic neuroma is also known as vestibular schwannoma, neurilemmoma or eighth nerve tumor.* It arises from superior division of vestibular nerve.* The tumor arises from the Schwann cells of the vestibular, but rarely from the cochlear division of 8th nerve within the internal auditory canal.Clinical Features* Age and sex: Mostly seen in age group of 40-60 years. Both sexes are equally affected.* Cochleovestibular symptoms# They are the earliest symptoms.# Most commonly manifests by Progressive unilateral sensorineural hearing loss, often accompanied by tinnitus.# Vestibular symptoms are imbalance or unsteadiness.* Cranial nerve involvement# Cranial nerve 5th is the earliest nerve to be involved (after 8th)causing loss of corneal reflex# MC clinical finding of acoustic neuroma- loss of corneal reflex# CN 7th involvement: although rare, it causes numbness or paraesthesia of face# Hitzelberger sign: Hypoaesthesia around posterior auricular area (due to CN 7th involvement)# In CN 8th Sensory fibres are affected early.# 9th and 10th nerves: There is dysphagia and hoarseness due to palatal, pharyngeal and laryngeal paralysis.* Brainstem involvement# There is ataxia, weakness and numbness of the arms and legs with exaggerated tendon reflexes.* Cerebellar involvement# Revealed by finger-nose test, knee-heel test, dysdiadochokinesia, ataxic gait, inability to walk along a straight line with tendency to fall to the affected side.* Raised intracranial tension* This is also a late feature.* There is headache, nausea, vomiting, diplopia and papilloedema with blurring of vision.
Ataxic gait
Diplopia
Sensorineural hearing loss
Parasthesia
Tumors