Acoustic Neuroma

What is acoustic neuroma? 

Acoustic neuroma, also known as vestibular schwannoma, is a benign tumour that develops on the vestibular nerve, which connects the inner ear to the brain. An acoustic neuroma is a benign (non-cancerous) tumour that can affect hearing and balance. 

Many people with acoustic neuromas notice  hearing loss and tinnitus (ringing in the ears). Usually, only one ear is affected, but both ears can be involved if the person has a rare genetic disease called neurofibromatosis type 2.  

Neurofibromatosis is a genetic condition characterised by benign tumour growth.

Usually, acoustic neuromas grow very slowly. This implies you may not have any indications in the early stages when the tumour is little.

Whether or not there are any other symptoms can depend on the tumour size and how hard it presses on the acoustic nerve.

Some people with an acoustic neuroma experience: 

• Loss of balance, dizziness or vertigo (spinning sensation) 
• Headache 
• Facial numbness or tingling 
• Blurred vision 
• Problems with coordination on one side of the body.

Medical history review: Your doctor will ask you about your symptoms, including any hearing loss, tinnitus (ringing in the ears), balance problems, or other related issues. They’ll also inquire about your general health and any relevant medical conditions.

Physical examination: A physical examination may include tests to assess your hearing, balance, and coordination. Your doctor may use an otoscope to look into your ears and evaluate your ear canal and eardrum.

Comprehensive audiological evaluation: It assesses the individual’s hearing ability. It typically involves several tests and procedures conducted by an audiologist. These may include checking the ears for any visible issues, measuring the softest sounds a person can hear across different frequencies, assessing speech understanding, evaluating middle ear function, and measuring responses to sound at the level of the inner ear and brainstem.

MRI (Magnetic Resonance Imaging):This imaging test is usually the most definitive way to diagnose an acoustic neuroma. MRI provides detailed images of the internal structures of the brain and inner ear, allowing doctors to visualize the tumor and determine its size and location.

CT (Computed Tomography) scan: While less common than MRI, a CT scan may also be used to evaluate the brain and inner ear. It can provide detailed images that help in diagnosing acoustic neuroma, especially if MRI is not feasible for some reason.

Videonystagmography (VNG): These tests evaluate the function of the vestibular system and can help determine if the tumor is affecting balance and coordination.

Vestibular Evoked Myogenic Potentials (VEMP): VEMP is on the most used clinical tests as part of comprehensive vestibular evaluation to help identify any signs of Acoustic Neuroma / Vestibular Schwannoma.

Treatment options for acoustic neuroma depend on factors such as the tumour size, rate of growth, symptoms, and the patient’s overall health.  

Here are the common treatment options: 

• Observation (watchful waiting): If the tumor is small and not causing symptoms, doctors may recommend regular monitoring with periodic MRI scans to track its growth. 
• Surgery: Surgical removal of the tumor is often considered if the tumor is large, growing rapidly, or causing significant symptoms such as hearing loss, balance problems, or facial weakness. The goal of surgery is to remove the tumor while preserving neurological function. The specific surgical approach can vary, but techniques such as microsurgery or minimally invasive endoscopic surgery may be utilized.
• Radiation therapy: Radiation therapy, such as stereotactic radiosurgery (e.g., Gamma Knife or CyberKnife), may be recommended for smaller tumors or for patients who are not good candidates for surgery due to factors like age or health conditions. Radiation therapy aims to shrink or control the growth of the tumor by targeting it with high-dose radiation while minimizing damage to surrounding healthy tissue.
• Hearing Aids: As a result of tumor growth and may be due to surgery or radiation therapy hearing loss may become permanent and may some patients may also notice ringing sensation called Tinnitus. To treat hearing loss and tinnitus Hearing Aids is recommended.
• Vestibular Rehabilitation Therapy: Depending on the location of tumor on Vestibulocochlear nerve and due to the procedure some patients may experience vertigo and dizziness, to overcome vertigo and dizziness a specialized vestibular rehabilitation would be highly recommended.