The results of attempted hearing preservation were investigated in 160 cases of acoustic neuroma surgery carried out by a team of otologists and neurosurgeons at Keio University Hospital during a 14-year period from 1976 to 1989. Surgery was carried out by the middle cranial fossa (MCF) approach in the earlier cases and by the extended middle cranial fossa (EMCF) approach in the more recent cases. Measurable postoperative hearing was preserved in 20 of the 160 cases. Preoperatively, 22 cases had tumors of 20 mm or smaller in diameter, hearing levels (HL) of 50 dB or lower, and speech discrimination scores (SDS) of 50% or higher; 8 (36%) met these conditions postoperatively. Among those cases with hearing preserved postoperatively, hearing was unchanged from the preoperative level in 9 cases and changed in 11 cases. Total tumor removal was achieved in 19 cases. In one case, part of the tumor was left in order to preserve hearing, but MRI and CT have revealed no change in hearing or tumor enlargement to date, at 4 1/2 years after surgery. Hearing was preserved but progressively deteriorated postoperatively in one case in which the tumor was believed to have been totally removed but there was recurrence and in another case of total resection of neurofibromatosis II. Postoperatively, there were increased incidences of absence of the stapedius reflex, Type V by Békésy audiometry, and prolongation of the IT5, disappearance of Wave V, and no response in measurements of the ABR.