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 lateralization to the normal ear in Weber test, decreased or absent ipsilateral corneal reflex, and facial twitching or hypesthesia.[1]

Physical Examination

Diagnosis of acoustic neuromas begins with a history and physical examination, followed by otologic testing, and finally radiologic scanning.

Ear Examination

  • Sensorineural hearing loss in the affected ear
  • Rinne test is positive
  • 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 lateralizes to normal ear.[2]

Eye examination

Neurological Examination

Often, the physical exam is normal at the time the tumor is diagnosed. Occasionally, the following cranial nerves may be affected:[1]

  • 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.
  • Cranial nerve IX- the back half of the tongue can lose its sense of taste.
  • Cerebellum: The following tests may be positive:
  • Romberg, Hall-Pike, and other balance tests are typically normal.

References

  1. 1.0 1.1 Acoustic neuroma. Medline Plus(2015) https://www.nlm.nih.gov/medlineplus/ency/article/000778.htm Accessed on October 2 2015
  2. Vestibular Schwannoma. Wikipedia(2015) https://en.wikipedia.org/wiki/Vestibular_schwannoma Accessed on October 2 2015

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