Objective To explore the clinical characteristics and influencing factors of early postoperative vestibular symptoms in patients with acoustic neuroma by collecting preoperative vestibular function examination, clinical data, and early postoperative vestibular symptom data. Methods The study included 64 patients who had undergone surgery for acoustic neuroma between February 2021 and February 2022. Vestibular symptom types were recorded postoperative 1 day, 3 days, 7 days, 30 days respectively, and the severity of vestibular symptoms were assessed using visual analogue scale for vestibular symptoms (VAS-V). Patients were divided into the vestibular symptom relief group (VAS-V≤ 2) and the vestibular symptom persistence group (VAS-V>2) based on the median VAS-V score at 30 days postoperatively (VAS-V median score=2). Differences in demographic information, Koos grade, and preoperative vestibular examination results were compared between the two groups. A binary logistic regression model was constructed to explore the influencing factors for the persistence of early postoperative vestibular symptoms. Results Vestibular symptoms were most pronounced on postoperative day 3, and there was no significant change in vestibular symptoms from postoperative day 7 to day 30. The most common vestibular symptoms 30 days after the surgery were dizziness and postural symptoms, in 33 cases (51.6%) and 31 cases (48.4%), respectively. Binary logistic regression analysis showed that normal video-head impulse test (vHIT) gain (OR=4.06, P=0.039), cold calorics test unilateral weekness (UW) <75% (OR=12.45, P=0.001), and gender (OR=0.22, P=0.038) were independent risk factors for the persistence of vestibular symptoms at 30 days postoperatively. Conclusions Preoperative vestibular function and gender are important factors in predicting postoperative vestibular symptoms in patients with acoustic neuroma, and the degree of preoperative vestibular function injury is negatively correlated with the duration of postoperative vestibular symptoms, which is helpful to providing references for early postoperative vestibular function recovery in patients with acoustic neuroma. [ABSTRACT FROM AUTHOR]