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Dr. Andrew Rynne

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Article Home Ear Nose and Throat Disorders Acoustic Neuroma

Acoustic Neuroma

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Acoustic neuroma, also called a vestibular schwannoma, is a benign primary intracranial tumor VIII cranial nerve.

 

The signs and symptoms of acoustic neuroma develop from a tumor pressing on VIII cranial nerves.

Signs and symptoms

  • Gradual hearing loss, although sudden in some cases and occurring on only one side or more pronounced on one side. Its sensorineural hearing loss.
  • Ringing sensation (tinnitus) in the affected ear
  • Pressure in the ear
  • Dizziness (vertigo)
  • Nausea and vomiting
  • Loss of balance or equilibrium
  • Altered gait

The tumor also may press on the brainstem structures (pons, midbrain, and medulla). If facial nerve (VII cranial nerve) is involved

  • Ipsilateral facial weakness and numbness
  • Impairment of sensations
  • Impairment of glandular secretions
  • Loss of taste sensation in the anterior two-thirds of the tongue

If trigeminal nerve (V cranial nerve) is involved

  • Loss of sensation in the involved side's face and mouth

If glossopharyngeal (IX cranial nerve) and vagus nerves (X cranial nerve) involved

  • Involvement may lead to altered gag or swallowing reflexes.

In rare cases, an acoustic neuroma may grow large enough to compress the brainstem and be life-threatening. Its associated symptoms such as headache, vomiting, and altered consciousness

Causes

  • Most of the acoustic neuromas develop on a vestibular branch of 8 th cranial nerve
  • The cause of acoustic neuromas is unknown or idiopathic
  • Tumors, in rare cases, are an indication of neurofibromatosis 2, a genetic disorder that involves the growth of tumors on the vestibulocochlear nerve.
  • Tumors associated with neurofibromatosis often affect the nerve on both sides (bilateral).

 

Complications

  • Permanent hearing loss
  • Facial numbness and weakness
  • Difficulty in balance and clumsy gait

Tests and diagnosis

  • MRI with gadolinium enhancement is the test of choice
  • MRI or CT brain to confirm the diagnosis
  • Hearing test- Audiometry
  • Electonystagmography (ENG)
  • Brain stem auditory evoked response (BAER)

Treatment

Monitoring

  • In small acoustic neuroma that’s not growing or is growing slowly and causes few or no signs or symptoms, frequent monitoring is required, especially in an older adult
  • Regular imaging with CT or MRI and hearing tests are required to determine whether the tumor is growing and how quickly.
  • If the scans show the tumor is growing or if the tumor causes progressive hearing loss or other difficulties, there is a need to undergo treatment.

Stereotactic radiosurgery

Surgical removal

  • The goal of surgery is to remove the tumor and preserve the facial nerve to prevent facial paralysis and preserve hearing.
  • Performed under general anesthesia, this type of surgery involves removing the tumor through an incision in your skull.