Early diagnosis of small auditory neuromas is key to obtaining functional resection of the tumor and preserving the facial and auditory functional nerves. Since small auditory neuromas mainly present with cochlear and vestibular symptoms, a thorough and detailed otolaryngological examination is necessary to differentiate them from facial neuromas, vestibular neuritis optica, sudden deafness, and other common inner ear diseases. The final diagnosis can only be confirmed by imaging of the internal auditory tract and pontocerebellar horn. Larger auditory neuromas may show signs of V, VII, VIII cerebral nerve or posterior group cerebral nerve involvement . Typical nerve sheath tumors have the following characteristics: 1. Early symptoms begin with damage to the vestibular and cochlear nerves of the auditory nerve and manifest as vertigo, progressive unilateral hearing loss with tinnitus. The first symptom is tinnitus and deafness. The tinnitus often lasts for a short time, while the deafness develops slowly and can last for several years or ten years, so most of them are not noticed by patients. 2.The tumor adjacent to the cranial nerve damage, generally the trigeminal nerve and facial nerve damage is common, manifested as peripheral facial palsy on the affected side, or numbness of the affected side, weakness or atrophy of the occlusal muscles. 3, and then appear unstable walking, uncoordinated movements and other signs and symptoms. 4.Headache, nausea and vomiting. The symptoms of increased intracranial pressure such as optic papilledema, and the manifestations of posterior group cranial nerve damage such as dysphagia, choking and coughing with water, hoarseness, etc. According to the typical evolution of the patient’s condition and specific manifestations, the diagnosis is not difficult. However, the key to the problem lies in early diagnosis. It is better to make accurate diagnosis at the “otologic” stage of vestibular nerve and cochlear nerve damage or when the tumor is confined to the internal auditory canal, so as to improve the total resection rate of the tumor, reduce the risk of surgery, and preserve the function of facial and auditory nerves to the greatest extent possible. Patients with the following symptoms in early stage should consider the possibility of auditory nerve sheath tumor: 1. intermittent onset or progressive aggravation of tinnitus: 2. progressive hearing loss or sudden deafness. 3. 3.Dizziness or momentary unstable sensation when changing position. 4. Intermittent tingling in the deep external auditory canal or deep mastoid area. Patients in the “otologic” stage often lack other neurological symptoms and signs besides tinnitus and hearing loss, and most patients go to the otologic clinic. Patients with hearing loss around middle age, without other causes such as trauma or otitis media, should consider the possibility of an auditory nerve sheath tumor. Hearing and vestibular function examinations, as well as subencephalic evoked potentials and general radiological examinations should be performed, and if necessary, cranial CT and magnetic resonance examinations should be performed to further clarify the diagnosis. Audiological examination: It mainly includes pure tone audiometry, brainstem auditory evoked potentials, speech audiometry, etc. Since auditory neuroma often causes unilateral or bilateral hearing damage, patients can quickly, non-invasively and effectively find out the degree of hearing alteration and impairment, and provide guidance for surgery and postoperative hearing reconstruction to improve the quality of life through the above examinations. Brainstem auditory evoked potentials or brainstem electrical response audiometry is a non-invasive electrophysiological examination, and a positive finding is a delayed or absent V-wave, which is present in more than 95% of auditory nerve sheath tumors and is now widely used for the early diagnosis of this tumor. Vestibular function test: If spontaneous nystagmus is recorded to the healthy side, it indicates that the tumor has started to compress the brainstem and cerebellum. Nystagmus is mostly horizontal at first, but may change to vertical or oblique later. If optokinetic palsy is present, it indicates brainstem optokinetic pathway involvement. A variable temperature test may reveal partial or complete paralysis of the affected horizontal hemianopia with a dominant bias toward the affected side. Neurological examination: The presence of trigeminal nerve signs such as blunted or absent corneal reflex indicates tumor diameter >2.5cm; the presence of cerebellar signs indicates that the tumor diameter has reached 4cm, and the above larger tumor may compress or stimulate facial nerve causing facial palsy or facial muscle spasm and may lead to contralateral central facial palsy. Radiographs: The main changes are bone resorption resulting in the enlargement of the internal auditory canal and abnormalities in the rock tomogram. Cerebral angiography: The lesions seen are characterized by: the basilar artery moving toward the slope; the anterior central cerebellar vein moving backward; the pontine and anterior midbrain veins moving toward the slope; the choroid point moving backward; in larger lesions, the anterior inferior cerebellar artery is also seen to be pushed by the mass from the internal auditory tract, and both the basilar artery and the pontine and anterior midbrain veins move backward; the basilar artery may move to the opposite side; and the tumor is colored. The current standard for the diagnosis of auditory nerve sheath tumor is Gd-DTDA-enhanced MRI, especially when the tumor is small (<1 cm) or within the internal auditory tract, and a negative ct scan and high suspicion of tumor presence should be performed with gd-dtpa-enhanced mri. ct and mri have complementary roles, such as when ct finds an enlarged internal auditory tract on the diseased side, enhanced ct can find The tumor is useful for estimating the degree of temporal bone pneumatization during middle cranial fossa approach and the distance between the high jugular venous bulb and the posterior semicircular canal and floor. If the patient has made a ct and the tumor is large, mri can provide the extent of compression on the brainstem whether the ventricles are patent for hydrocephalus and whether it is present For suspected auditory nerve sheath tumor or when the ct examination is difficult to determine, mri of the full sequence can make the differential diagnosis. However, it is also important to be aware of possible false positives for gd-dtpa, which is associated with inflammation of the nerves within the internal auditory tract or arachnoiditis; any small enhancing lesions near the base should be reviewed by mri in June to assess their growth.