Acoustic Neuroma

Acoustic neuroma, also known as vestibular schwannoma, is a non-cancerous tumor that develops on the vestibular nerve, which connects the inner ear to the brain. While these tumors are typically slow-growing and benign, they can cause significant symptoms as they press on nearby structures in the brain and inner ear. In this article, we’ll explore the causes, symptoms, diagnosis, and treatment options for acoustic neuroma.

Causes of Acoustic Neuroma

The exact cause of acoustic neuroma is not always clear. However, it is believed to arise from Schwann cells, which are responsible for supporting and insulating nerve cells. 

Genetic factors may play a role in some cases, and there is a slightly increased risk associated with certain genetic disorders, such as neurofibromatosis type 2 (NF2). Exposure to high levels of radiation, such as those used in radiation therapy for head and neck tumors, may also increase the risk of developing an acoustic neuroma.

Symptoms of Acoustic Neuroma

The symptoms of acoustic neuroma can vary depending on the size and location of the tumor. Common symptoms may include:

  1. Hearing Loss: Gradual or sudden hearing loss, typically affecting one ear, is one of the most common early symptoms of acoustic neuroma. This hearing loss is often gradual and may initially be mistaken for age-related hearing loss.

  2. Tinnitus: Ringing, buzzing, or hissing sounds in the affected ear, known as tinnitus, may occur. This symptom can vary in intensity and may be constant or intermittent.

  3. Vertigo and Balance Problems: Vertigo, or the sensation of spinning or dizziness, is another common symptom of acoustic neuroma. Patients may also experience balance problems, unsteadiness, or a feeling of being off-balance.

  4. Facial Weakness or Numbness: As the tumor grows and compresses nearby nerves, it can lead to facial weakness or numbness on the side of the face where the tumor is located.

  5. Headaches: In some cases, acoustic neuroma may cause persistent headaches, particularly if the tumor grows large enough to exert pressure on the brain.

Diagnosis of Acoustic Neuroma

Diagnosing an acoustic neuroma typically involves a combination of medical history, physical examination, and diagnostic tests. A thorough examination of the ears, hearing tests (audiometry), and balance tests (electronystagmography or ENG) may be performed to assess hearing loss and balance function. Imaging studies such as magnetic resonance imaging (MRI) with gadolinium contrast are essential for visualizing the tumor and determining its size and location.

Treatment Options

Treatment for acoustic neuroma depends on several factors, including the size and growth rate of the tumor, the patient’s age and overall health, and the severity of symptoms. Treatment options may include:

  1. Observation: In some cases, particularly for small tumors with minimal or no symptoms, a strategy of watchful waiting or observation may be recommended. Regular monitoring with MRI scans allows doctors to track the tumor’s growth and intervene if necessary.

  2. Surgery: Surgical removal of the tumor (microsurgical resection) may be recommended for larger tumors or those causing significant symptoms. During surgery, the goal is to remove as much of the tumor as possible while preserving nearby nerves and brain structures.

  3. Radiation Therapy: Stereotactic radiosurgery, such as gamma knife or cyber knife radiation, may be considered for smaller tumors or patients who are not good candidates for surgery. This non-invasive approach delivers focused radiation to the tumor, aiming to stop its growth over time.

  4. Medication: While medications cannot cure acoustic neuroma, they may help manage symptoms such as vertigo, tinnitus, and facial pain. Medications may include vestibular suppressants for dizziness or anti-seizure medications for facial pain.

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