Acoustic neuroma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Common physical examination findings of acoustic neuroma include abnormal Weber test, decreased or absent ipsilateral corneal reflex, facial twitching or hypesthesia, and abnormal caloric stimulation test.

Physical Examination

Diagnosis of acoustic neuromas begins with a history and physical examination, followed by otologic testing, and finally radiologic scanning. MRI scan with gadolinium enhancement is the most common radiological test. On the scan, the size and shape of the tumor can be visualized.

Ear Examination

• Sensorineural hearing loss in the affected ear
• Weber test lateralizes to the normal ear
• Rinne test is positive
• Earache may be present

Eye examination

• Nystagmus may be present

• Papilledema may be present
• Diplopia on lateral gaze may be present

Neurological Examination

Often, the physical exam is normal at the time the tumor is diagnosed. Occasionally, the following cranial nerves may be affected:

• Cranial nerve V- A decreased or absent ipsilateral corneal reflex.
• Cranial nerve VII- Facial twitching or hypesthesia may occur. Drooling may occur. Drooping on one side of the face may occur. Loss of taste may occur.
• Cranial nerve VIII- In sensorineural hearing loss Rinne test is positive and Weber test is abnormal.
• Rinne test is positive: air conduction > bone conduction (both air and bone conduction are decreased equally, but the difference between them is unchanged).
• Weber test: Sound localizes to normal ear.
• Cranial nerve IX- the back half of the tongue can lose its sense of taste.
• Cerebellum: The following tests may be positive:
  • Caloric stimulation test may be abnormal.
  • Ataxia may be present.
• Romberg, Hall-Pike, and other balance tests are typically normal.
• Electronystagmography (ENG testing) is frequently abnormal. Unilateral loss of calorics is associated in about 50% of all tumors.