Delays in the diagnosis of acoustic neuromas.

From the medical files of 164 consecutive patients who underwent surgical treatment for a unilateral acoustic neuroma between 1980 and 1992, we collected data on the delay until the diagnosis was made. A distinction was made between the patient's and general practitioner's delay (delay 1) and the delay after the specialist's first visit until the radiologic diagnosis (delay 2). The average delay was 35.7 months (SD, 62.2) for delay 1 and 15.2 months (SD, 36.3) for delay 2. Specialist's delay (otolaryngologist or neurologist) was divided into a delay of a maximum of 12 months (134 patients) and a longer delay (30 patients). In 27 of the 30 patients, no specific tests had been performed, and in the remaining three, the test results were inconclusive. Reasons for not conducting further tests included familial hearing impairment, Meniere's disease, otosclerosis, and alcoholism. In cases in which the specialist had not made the diagnosis within 1 year, it took an average of 6 months extra to make the diagnosis of an acoustic neuroma, usually with a fairly short patient delay. The specialist's delay remained constant in the period of investigation, with the possibility of magnetic resonance imaging (MRI) scanning only in the last 2 years. In view of the increasing accessibility of MRI, it is now recommended if possible to perform MRIs in all patients with symptoms suspicious for an acoustic neuroma.

Acoustic neuroma: correlation among tumor size, symptoms, and patient age.

Due to improved diagnostic techniques, acoustic neuromas more frequently are detected at an early stage. Subsequent treatment depends on such factors as expected tumor growth rate, tumor size, and patient age. The natural history of acoustic neuromas is still uncertain: This study was performed to examine possible correlations among tumor size, patient age, signs and symptoms, and duration of symptoms. The study included 164 patients with an acoustic neuroma who were treated at University Hospital Nijmegen, The Netherlands, over a period of 13 years. Comparisons were made between the findings of this study and the reports in the literature. No support was found for any of the correlations mentioned in other studies, and no relationships could be demonstrated between the parameters evaluated in this study. The authors therefore recommend that treatment policies be based only on well-established correlations.