This article discusses the most direct and cost-effective means of diagnosing acoustic tumors. The sensitivity and specificity of current diagnostic tests are reviewed. Newer techniques, including magnetic resonance imaging (MRI), have changed the diagnosis of acoustic neurinomas. Our current recommendation is to do a screening auditory brainstem evoked response (ABR) if the neurotologic examination and audiometry indicate a possibility of tumor. If the audiogram and examination indicate a high probability of tumor, we may proceed directly to magnetic resonance scanning.