What is Acoustic Neuroma?
Acoustic neuroma is a noncancerous tumor that forms on the vestibular nerve - the nerve which runs from the inner ear to the brain and is responsible for balance. Relatively rare and slow-growing, acoustic neuromas are also called vestibular schwannomas because they are caused by an overproduction of Schwann cells - the cells that wrap around and protect the vestibular nerve. As the tumor grows, it can press against the hearing and facial nerves and affect the person’s hearing, balance or facial movements.
Your health is important. Don’t delay your care.If you have been diagnosed with or are experiencing symptoms of acoustic neuroma, it is essential to consult with a UH ENT specialist as soon as possible. Call 440-732-3821 today to schedule an in-person or virtual appointment with an ENT skull base specialist.
What Causes Acoustic Neuroma?
Acoustic neuroma can be unilateral (one ear) or bilateral (both ears) with unilateral being the most common type. Although it can develop at any age, it is usually diagnosed in adults between the ages of 30 and 60.
The exact cause of unilateral acoustic neuroma is unknown, but it is believed that environmental factors like past radiation therapy to the head and neck may increase an individual’s risk of developing this type of tumor. Bilateral acoustic neuroma is an inherited condition that can run in families and is associated with a genetic problem called neurofibromatosis-2 (NF2).
UH ENT Specialists Have the Expertise to Diagnose Acoustic Neuroma
The symptoms of acoustic neuroma can be very similar to those experienced with other middle and inner ear problems and may include:
- Hearing reduction or loss on one side
- Inability to hear high-frequency sounds
- Feeling of fullness in the ear
- Tinnitus (ringing in the ears)
- Balance problems or dizziness
- Facial numbness, facial weakness and tingling (rare, but can occur in large tumors)
- Mental confusion
Because of the wide variety of possible symptoms, acoustic neuromas can only be diagnosed by specially trained ear, nose and throat specialists. The ENT experts at University Hospitals will conduct a careful evaluation of each patient, including a medical history, physical exam and hearing test. In addition, diagnostic imaging tests such as CT or MRI will likely be ordered to confirm the diagnosis and pinpoint the location and size of the tumor so that an appropriate treatment plan can be developed.
Personalized Treatment Plans for Patients with Acoustic Neuroma
The treatment goal for patients with acoustic neuroma is to maintain hearing and balance, avoid facial paralysis and reduce any pain associated with the condition. In addition, if the tumor has grown large enough to press against the brain stem, treatment will be necessary to stop the growth of the tumor, shrink it or surgically remove it before it affects neurological function which can, in rare cases, be life threatening.
Each patient’s diagnostic and treatment team will include a variety of highly trained specialists and may include general otolaryngologists (ear, nose and throat specialists), otologists/neurotologists (ear and skull base surgeons), neurosurgeons, radiation oncologists, facial plastic surgeons, audiologists and physical therapists. Your team will work in close collaboration with you to create an individualized treatment plan that meets your unique needs.
Treatment plans will be determined based on your symptoms, age and general health and may include one or more of the following:
- Watchful Waiting
Also called active surveillance, watchful waiting may be the initial treatment approach for some patients, depending on the size and location of the tumor and the degree to which the symptoms are affecting their quality of life. If their symptoms are manageable, a watchful waiting approach is more likely with elderly patients for whom surgery might pose a higher risk.
- Lateral Skull Base Surgery
If surgery is determined to be necessary, our surgeons are specially trained and highly experienced in all surgical approaches to acoustic neuromas. These include:
- Translabyrinthine Approach: Access through the balance structures. This approach does not preserve hearing, but poses less strain to the brain structures during surgery.
- Retrosigmoid Approach: Access behind the balance and hearing structures. This approach can preserve hearing and be used for any tumor size.
- Middle Fossa Approach: Access over the hearing and balance structures. This approach can preserve hearing but is limited to small tumors.
- Transpromontory Approach: Access through the ear canal. This approach is limited to patients with small, growing tumors and with no hearing on the affected side.
Whenever possible, we use minimally invasive techniques to remove the tumor. Our team is committed to offering the best surgical treatment options in order to preserve hearing, maintain balance and minimize facial weakness.
- Radiation Therapy
Even though acoustic neuromas are benign (noncancerous), radiation therapy is often a component of treatment and may be used to stop the tumor from growing or to shrink the tumor. This can be offered as first line option, or after surgery when a small amount of the tumor is left behind to preserve the nerve that moves the face. Experts at University Hospitals use the most advanced image-guided radiation therapies to target the tumor including Gamma Knife and proton therapy which delivers extremely precise radiation dosing with limited exposure to surrounding healthy tissues.
- Vestibular and Facial Rehabilitation
If impaired balance or facial weakness is a symptom before or after treatment for acoustic neuroma, vestibular rehabilitation therapy or facial physical therapy may be recommended. These highly specialized types of physical therapy can train your body and brain to make up for inner ear dysfunction, and in cases of facial weakness, it can stimulate the recovery of facial movement.