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]


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.

Physical Examination

Diagnosis of acoustic neuromas begins with a history of asymmetric sensorineural hearing loss or other cranial nerve deficits according to the territory of involvement. 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][2][3]

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

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:

  • 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.


  1. Robert W. Foley, Shahram Shirazi, Robert M. Maweni, Kay Walsh, Rory McConn Walsh, Mohsen Javadpour & Daniel Rawluk (2017). "Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis". Cureus. 9 (11): e1846. doi:10.7759/cureus.1846. PMID 29348989. Unknown parameter |month= ignored (help)
  2. Xiang Huang, Jian Xu, Ming Xu, Liang-Fu Zhou, Rong Zhang, Liqin Lang, Qiwu Xu, Ping Zhong, Mingyu Chen, Ying Wang & Zhenyu Zhang (2013). "Clinical features of intracranial vestibular schwannomas". Oncology letters. 5 (1): 57–62. doi:10.3892/ol.2012.1011. PMID 23255894. Unknown parameter |month= ignored (help)
  3. C. Matthies & M. Samii (1997). "Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation". Neurosurgery. 40 (1): 1–9. PMID 8971818. Unknown parameter |month= ignored (help)