Acoustic Neuroma

An acoustic neuroma is a benign tumor that develops on the nerve that connects the ear to the brain

An acoustic neuroma is a benign tumor that develops on the nerve that connects the ear to the brain. The tumor usually grows slowly. As it grows, it presses against the hearing and balance nerves. At first, you may have no symptoms or mild symptoms. They can include

  • Loss of hearing on one side
  • Ringing in ears
  • Dizziness and balance problems

The tumor can also eventually cause numbness or paralysis of the face. If it grows large enough, it can press against the brain, becoming life-threatening.

Acoustic neuroma can be difficult to diagnose, because the symptoms are similar to those of middle ear problems. Ear exams, hearing tests, and scans can show if you have it.

If the tumor stays small, you may only need to have it checked regularly. If you do need treatment, surgery and radiation are options.

If the tumors affect both hearing nerves, it is often because of a genetic disorder called neurofibromatosis.

  • Unilateral Hearing Loss (on one side only) - This can sometimes occur suddenly (sudden hearing loss), but it generally can be very gradual, over months or years. In most acoustic neuroma patients, the loss is more pronounced in the higher frequencies. Unilateral hearing loss is usually the first symptom that leads to discovery of this benign brain tumor.
  • Tinnitus (ringing or buzzing in the ears) - Most AN patients do have tinnitus both before and after treatment. Not all patients with tinnitus have a brain tumor.
  • Feeling of fullness in the ears - Acoustic neuroma patients sometimes complain of a feeling that their ear is plugged or "full.”
  • Balance problems, vertigo - Acoustic neuroma patients often experience balance issues before diagnosis. It can occur very gradually and may go unnoticed as the body has many compensating mechanisms.
  • Headaches - Acoustic neuroma patients sometimes recall, after diagnosis, that they had unexplained headaches.
  • Facial pain, numbness, paralysis - Acoustic neuromas are usually discovered before they cause facial symptoms. However, if they are large or impacting one of the facial nerves, they can cause numbness, tingling or even facial paralysis.
  • Observation
  • Microsurgical Removal
  • Radiation: ("radiosurgery" or "radiotherapy")

Choosing the best treatment is a decision that must be made by both the patient and the physician after careful review of the size of the tumor, the location of it, the patient's age and physical health.  An open discussion should be encouraged about symptoms such as headaches, hearing loss, dizziness and facial numbness and the experience and treatment philosophy of the physicians involved in the patient’s care.  ANA recommends treatment from a medical team with substantial acoustic neuroma experience.

 

Surgical removal of an acoustic neuroma is a complex and delicate process. In general, the smaller the tumor at the time of surgery, the fewer the complications. The hospital stay after microsurgery is getting shorter, generally three to five days on average, with approximately four to six to twelve weeks suggested for recovery.  Longer stays may be necessary for patients with large tumors.  Patients routinely spend at least one night after surgery in the intensive care unit for close monitoring. The time after surgery can be filled with days or perhaps weeks of new sensations. There is usually head discomfort and fatigue. Some patients may experience emotional lows after major surgery, and those lows are believed to be a part of the natural healing process.  Some patients require a period of either outpatient or inpatient rehabilitation for balance issues.  Other potential postoperative complications (which are discussed preoperatively between patient and surgeon) may prolong hospitalization.

Even when tumor removal has been accomplished, there is a small chance of tumor recurrence. Therefore, a follow-up MRI after tumor removal should be performed within one to five years.

There are few acute side effects following SRS or FSR.  Hearing loss, if it is going to occur, usually happens several weeks or months after treatment and can continue to progress.  In radiosurgery patients, tumor cell growth is not arrested immediately. Some tumor cells die in a matter of weeks, but others do so more gradually, generally 6 to 18 months after treatment. While this treatment usually arrests the growth of the tumor and some tumors will shrink in size, the tumor does not disappear. Follow-up scans are important because some tumors will continue to grow after this treatment or at some time in the future. It is not possible to determine which tumors will continue to grow larger after radiation. Therefore, periodic MRIs are necessary throughout life.

It is helpful to remain active after treatment, since this is the best way to combat the dizziness. Often the expertise of a qualified physical therapist can advance recovery.