Modern diagnostic procedures have enabled very early diagnosis of acoustic neuromas, making previously unattainable operative successes feasible. This change, which has taken place over the past decade, is demonstrated using data on 64 patients collected from 1970 to 1987. Over this period the case history shortened to a third, tumour size shrank to less than half and symptoms became more circumscribed and less severe. Operative results are impressive with regard to improvement or preservation of hearing and survival of the facial nerve. Technical diagnostic procedures can be reduced to a minimum of non-invasive methods. As very small intracanalicular neuromas can now be detected, there arises the question of the management strategy of choice, which would in selected cases include a period of watchful waiting.