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Acoustic Neuroma

An acoustic neuroma is a benign tumor that is located in the nerve that goes from the brain to the ear. It is usually a slow growing tumor that has no symptoms in the beginning. When symptoms develop, they are most commonly loss of hearing, tinnitus or ringing in the ear and an unsteady gait. It is also called a vestibular schwannoma; it is a rare cause of loss of hearing. While most of the time it grows slowly, it has the potential to grow quickly enough to push on the brain, interfering with important brain function.

The major symptoms of an acoustic neuroma come from the way the tumor pushes on nearby nerves, brain structures and blood vessels. The bigger it grows, the more and more severe the symptoms can become. On the other hand, size does not always reflect the symptoms you experience. The main symptoms of acoustic neuroma include the following:

  • Ringing just in the affected ear. This can be checked for by the doctor.
  • Hearing loss, which can be on both sides but is primarily worse on the affected side of the body.
  • Loss of balance or unsteadiness.
  • Facial weakness or numbness.
  • Dizziness, also known as vertigo.

In very uncommon situations, the tumor can get to a size that it impinges on the brainstem, which can be life threatening.

The cause of an acoustic neuroma has been determined by research. It appears to be related to a malfunctioning gene on chromosome 22. The gene normally makes a specific protein that slows the growth of Schwann cells that cover the 8th cranial nerve. The abnormal gene can be acquired after your born or can be hereditary. What is known is that the abnormal gene is an inherited gene in people who have neurofibromatosis type 2, which is a rare disorder that causes tumors under the skin. In these people, the acoustic neuroma can be bilateral.

The risk factors for acoustic neuroma can be being a relative with neurofibromatosis type 2. This is a rare condition—too rare to account for having every cause of acoustic neuroma. This is an autosomal dominant disorder so if your parent has the disease, you have a fifty: fifty chance of having the disease yourself. The genetics of this disorder is complex, however, because some people get the disease when they’re not supposed to.

Having a history of low dose radiation to the head seems to increase the risk of getting an acoustic neuroma.

There can be several complications of an acoustic neuroma, most of which are considered permanent. These complications include the following:

  • Facial weakness and numbness
  • Loss of hearing
  • Balance difficulties
  • Tinnitus or ringing in the ear
  • Hydrocephalus or fluid on the brain from pressure on the brainstem

What tests can be done to show an acoustic neuroma? A hearing test will show if there are areas of each ear that have diminished hearing. An ear exam can show if there is another cause of the hearing loss. A CT scan or an MRI scan can be done and, at the level of the acoustic nerve, the tumor can be detected.

The treatment of acoustic neuroma depends on where it is, its degree of growth and on the size at the time of diagnosis. If your tumor is small and slow growing, the doctor will just monitor the neuroma. This is especially true if you don’t have many symptoms from the tumor or are not a good candidate for surgery. You might have multiple routine hearing tests and follow up CT scans or MRI scanning. If there is no progression of symptoms or the size of the neuroma, the doctor will probably consider continuing to watch the progress of the tumor.

If there are symptoms worsening or if the size has increased, the doctor will recommend stereotactic radiosurgery. This can be done if the tumor isn’t too big. Radiation is precisely given to the acoustic neuroma using imaging scans to locate the tumor in your head. It takes several weeks or months to determine if the surgery worked.

You may instead have surgical removal of the tumor. Under general anesthesia, the tumor is taken out through the ear itself. In some cases it cannot be removed completely with one surgery. There can be complications of the surgery that make symptoms worse. This can include leakage of CSF, facial weakness, hearing worsening, facial numbness, worsening balance or tinnitus, headache, meningitis and stroke.

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