What are typical presenting symptoms of an acoustic neuroma and its standard management options?

• A. Progressive bilateral sensorineural hearing loss.
• B. Bilateral conductive hearing loss.
• C. Progressive unilateral sensorineural hearing loss, tinnitus, dizziness; management includes observation, surgical resection, or radiosurgery depending on size and symptoms.
• D. Loss of smell.

Answer: (C)

Acoustic neuroma, a vestibular schwannoma, typically affects the eighth cranial nerve on one side, so it most often presents with a progressive unilateral sensorineural hearing loss accompanied by tinnitus and sometimes dizziness or imbalance as the tumor grows and compresses the vestibular and cochlear pathways. The unilateral nature helps distinguish it from other patterns, since bilateral symptoms would raise concern for conditions like neurofibromatosis type 2 rather than a sporadic tumor. Conductive hearing loss points to middle-ear pathology rather than a nerve tumor, and loss of smell is unrelated to this tumor’s location.

How this is managed depends on tumor size and symptoms. Small, asymptomatic, or stable tumors may be watched with regular imaging. Larger or symptomatic tumors are often treated with surgical resection to remove the mass, while radiosurgery (such as Gamma Knife) offers a less invasive option to control growth and preserve function, especially when aiming to avoid or delay open surgery or in patients who are poorer surgical candidates.