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The records of 225 patients with surgically documented acoustic neuromas seen at the Mayo Clinic between 1966 and 1976 were studied. Included in this group were 4 patients who had von Recklinghausen's disease with bilateral ear involvement, 7 patients with recurrence of acoustic neuroma; and 8 patients who were referred because of recurrent acoustic neuroma. Symptoms, clinical findings, and results of audiologic, vestibular, and roentgenographic studies were analyzed. Nine patients had a history of sudden onset of hearing loss, and 11 had a history of vertigo. A correlation between the size of the lesion and the symptoms, physical findings, and roentgenographic accuracy was made in an attempt to gain further knowledge of the natural course of the pathologic processes involved.