An unusual case history of a patient with an acoustic neurinoma is reported. The patient had a two-year history of unilateral sensori-neural hearing impairment, normal radiological appearance of the internal acoustic meatus at tomography and on CT a grossly calcified tumour in the cerebello-pontine angle, indicating pathology other than an neurinoma. Vertebral angiography was normal, and at surgery a grossly calcified tumour was found, while microscopy revealed a typical neurinoma pattern. The tumour had to be removed in two stages, both via the translabyrinthine approach, with a satisfactory post-operative condition, including near-normal facial function. It is concluded that dense calcifications in tumours in the cerebello-pontine angle do not necessarily exclude a neurinoma, and vertebral angiography is therefore not indicated routinely. However, such findings do predict difficulties at surgery.

Masking of tinnitus by acoustic stimuli seems to be a very simple phenomenon, reflecting everyday experience. The buzzing of a mosquito is drowned by the noise of a jet-plane. That is self-evident and does not need any explanation. It seems to be a perfect analogue to the masking of tinnitus. But if we look into these two situations more closely we find fundamental differences between them, which ask for interpretation.

The lack of loudness of tinnitus, as first pointed out by Fowler (1942), has been an item of confused concern ever since. The point being this: How can so weak a sensation produce such severity of stress? The present article deals with this item by attempting to provide a more objective psychological measure of severity of tinnitus. The U.S. Health Survey, which estimated that one out of five patients with tinnitus have it in its severe form, is but one example of differentiating mild vs. severe tinnitus. In the severe group, there are some for whom the tinnitus is constant and unrelenting, while for others the bad spells come and go without warning or reason. Whether constant or fluctuating, these patients perceive their tinnitus as a severe affliction which greatly degrades the quality of their life. We accept these subjective statements and ratings of their distress; however, there is a serious need for an objective measure of severity. The present report attempted such a measure by using the degree to which tinnitus was maskable by environmental sounds. The results correlated no better with ratings of severity than do the measures of loudness of tinnitus.