The treatment of acoustic neuroma and Menière's disease in the same patient.

Although total excision is accepted as the standard of care in the treatment of acoustic neuromas, for the elderly patient this approach is modified. Small tumors which cause only eighth nerve symptoms of hearing loss and tinnitus can be followed radiologically while larger tumors with brain stem compression may be subtotally excised through the translabyrinthine route. Our standard treatment for Menière's disease--that is refractory to medical management--has been vestibular nerve section through a retrolabyrinthine approach. In the event of bilateral Menière's disease or Menière's disease in an only hearing ear, treatment with low-dose intramuscular injections of streptomycin sulfate is preferred. Two elderly patients are discussed, each of whom has an acoustic neuroma in one ear and Menière's disease in the other. These patients' histories, diagnostic evaluations, treatment rationale, and follow-up data are presented to illustrate the decision-making process and the management of complicated and unusual cases.