Acoustic Neuroma: Symptoms, Diagnosis, and Treatment

Written by Medicover Team and Medically Reviewed by Dr Prachi Rahul Pawar , Neurologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Acoustic neuroma, also known as vestibular schwannoma, is a benign (non-cancerous) tumour that develops on the vestibulocochlear nerve, which connects the inner ear to the brain. This nerve is responsible for hearing and balance, so an acoustic neuroma can significantly impact these functions.

What Are the Symptoms of Acoustic Neuroma?

The symptoms of an acoustic neuroma can vary widely, depending on the size and location of the tumour. Common symptoms include:

Hearing Loss

Hearing loss, particularly in one ear (unilateral hearing loss), is often the earliest and most common symptom. Hearing loss is usually gradual but can sometimes occur suddenly.

Tinnitus

Tinnitus, or ringing in the ear, is another frequent symptom. This ringing can be continuous or intermittent and is often described as a high-pitched sound.

Balance Issues

The vestibulocochlear nerve also plays a critical role in maintaining balance. Tumours on this nerve can cause vertigo, unsteadiness, or a sense of imbalance.

Facial Numbness or Weakness

As the tumour grows, it may compress adjacent cranial nerves, leading to facial numbness, tingling, or muscle weakness.

Headaches

Increased intracranial pressure can lead to headaches in larger tumours. This is more common when the tumour compresses the brainstem or obstructs cerebrospinal fluid flow.

What Are the Causes and Risk Factors?

Genetic Factors

Most cases of acoustic neuroma are sporadic, meaning they occur without a known cause. However, in some instances, they are associated with a genetic disorder called Neurofibromatosis Type II (NF2). Individuals with NF2 are at a higher risk of developing bilateral acoustic neuromas.

Environmental Factors

Limited evidence suggests that environmental factors, such as prolonged exposure to loud noise or radiation, may contribute to the development of acoustic neuromas. However, more research is needed to establish these links.

What Are the Types of Acoustic Neuroma?

Unilateral Acoustic Neuroma

This is the most common type and affects only one ear. It is typically sporadic and not inherited.

Bilateral Acoustic Neuroma

This type is less common and usually associated with Neurofibromatosis Type II (NF2). It affects both ears and is inherited in an autosomal dominant pattern.

When to See a Neurologist?

Acoustic neuroma symptoms can gradually worsen and significantly impact daily life. Persistent hearing changes, balance problems, or facial symptoms may indicate tumor growth requiring prompt medical evaluation and possible intervention.

You should see a doctor if you have:

Gradual or sudden hearing loss in one ear, persistent ringing (tinnitus), or a feeling of fullness in the ear that does not resolve on its own.
Recurring dizziness or balance difficulties that interfere with walking, working, or performing everyday activities safely.

Get medical help immediately if:

You experience sudden, severe hearing loss or complete loss of hearing in one ear within a short period of time.
Facial numbness, weakness, or paralysis develops, especially if accompanied by difficulty swallowing or speaking.
Intense headaches, vision changes, or loss of coordination occur, suggesting increased pressure within the skull.

These could be signs of a serious complication like Acoustic Neuroma, which needs urgent care.

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How is the Diagnosis of Acoustic Neuroma Performed?

Hearing Tests

An audiogram can assess the extent of hearing loss and help distinguish between conductive and sensorineural hearing loss.

Imaging Studies

Magnetic Resonance Imaging (MRI) is the gold standard for diagnosing acoustic neuroma. It provides detailed images of the brain and inner ear structures, allowing for precise localisation and measurement of the tumour.

Auditory Brainstem Response (ABR) Testing

ABR testing measures the electrical activity of the auditory nerve and brainstem in response to sound. It can help identify abnormalities in nerve function.

What Are the Treatment Options for Acoustic Neuroma?

Observation

In cases of small, asymptomatic tumours, a "watch and wait" approach may be adopted. Regular MRI scans and hearing tests monitor tumour growth and any progression of symptoms.

Microsurgical Removal

For larger or symptomatic tumours, surgical removal may be necessary. The three main surgical approaches are:

Translabyrinthine Approach: This approach allows for complete tumour removal but results in permanent hearing loss in the affected ear.
Retrosigmoid (Suboccipital) Approach: This method provides access to the tumour while attempting to preserve hearing, although this is not always possible.
Middle Fossa Approach: This approach is used for small tumours and aims to preserve hearing.

Stereotactic Radiosurgery

Stereotactic radiosurgery, such as Gamma Knife or CyberKnife, delivers focused radiation to the tumour, causing it to shrink or stop growing. This non-invasive treatment is often used for smaller tumours or for patients who are not candidates for surgery.

Fractionated Stereotactic Radiotherapy (FSR)

FSR delivers radiation in smaller doses over several sessions, minimising damage to surrounding tissues. It is an alternative to single-session radiosurgery.

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Preventing Acoustic Neuroma

Currently, there are no established methods to prevent acoustic neuroma, mainly since most cases occur sporadically. However, early diagnosis and intervention can prevent complications and improve outcomes.

Genetic Counseling

For individuals with a family history of Neurofibromatosis Type II (NF2), genetic counselling and testing may help identify at-risk individuals and guide monitoring and early intervention strategies.

Regular Hearing and Balance Assessments

Regular hearing and balance assessments can help detect early signs of acoustic neuroma, especially in individuals with known risk factors.

Living with Acoustic Neuroma

Rehabilitation

After treatment, patients may require rehabilitation to address hearing loss, balance issues, and facial nerve function. Physical therapy, occupational therapy, and speech therapy can aid in recovery and improve quality of life.

Support Groups

Joining support groups for acoustic neuroma patients can provide emotional support, practical advice, and a sense of community. These groups often offer resources and information about living with the condition and managing its effects.

Ongoing Monitoring

Even after successful treatment, ongoing monitoring with regular MRI scans and hearing tests is essential to detect any recurrence or growth of residual tumour tissue.

Frequently Asked Questions

1. What causes acoustic neuroma?

Acoustic neuroma is a benign tumor that develops on the vestibulocochlear nerve, often due to genetic factors like neurofibromatosis type 2 (NF2).

2. How is acoustic neuroma treated?

Treatment options include monitoring, radiation therapy, or surgical removal of the tumor, depending on the size and symptoms.

3. Can acoustic neuroma be prevented?

Acoustic neuroma is primarily genetic, so there is no known way to prevent it, but early detection can help manage symptoms effectively.

4. What are the symptoms of acoustic neuroma?

Symptoms include hearing loss, ringing in the ear (tinnitus), dizziness, and balance problems. Larger tumors can cause facial numbness or weakness.

5. How is acoustic neuroma diagnosed?

Diagnosis is confirmed through hearing tests (audiometry), MRI scans, and sometimes balance tests to assess the impact on the vestibulocochlear nerve.