26/09/2026
🧠 Vestibular Schwannoma:
When “Just Asymmetric Hearing Loss” Needs More Attention
Slowly progressive unilateral sensorineural hearing loss, especially with unexpectedly poor speech discrimination, is the classic presentation of vestibular schwannoma.
👂 Key presentation: The commonest symptom is unilateral, slowly progressive sensorineural hearing loss, mainly affecting high frequencies, with or without tinnitus. Sudden hearing loss may be the first presentation in 5–10%.
🎧 Audiometry clue:
-Pure-tone audiometry typically shows asymmetrical high-frequency sensorineural hearing loss
-Speech Discrimination Score (SDS) poorer than expected for the hearing thresholds.
🧠 Think tumour size: Larger lesions may cause chronic disequilibrium, facial paraesthesia/trigeminal neuralgia, hydrocephalus, and eventually brainstem-compression features.
🔍 Investigation:
-Magnetic Resonance Imaging (MRI) of the internal auditory meatus and cerebellopontine angle, with and without contrast, is the gold-standard investigation.
-Auditory Brainstem Response (ABR) has a high false-negative rate, particularly for small tumours.
💎 Clinical Pearl
Asymmetric high frequency sensorineural hearing loss + disproportionately poor speech discrimination = investigate for vestibular schwannoma with MRI.
