What Is Acoustic Neuroma (Vestibular Schwannoma)?
An acoustic neuroma is a tumor of the Schwann cells (insulation for nerve fibers). These tumors do no spread throughout the body, but can become life-threatening if they grow too large and press on the brain. These tumors are typically found on only one side of the head.
Acoustic Neuroma Frequency
This tumor is found in about one out of every 100,000 members of the population. Acoustic neuromas generally occur in adults between the ages of 30 and 60.
At University of Utah Health, our specialists are highly trained in recognizing the symptoms and using the best surgical methods to remove acoustic neuromas safely and effectively.
Make an Appointment with Our Specialists
If you believe you need an evaluation for an acoustic neuroma, you can make an appointment with one of our skull base tumor specialists.
No doctor referral is necessary to come visit us, but please check with your insurance first as some insurance companies require referrals.
Get a Consultation
Not located in Utah? You can contact us for a consultation. Once you have submitted the following, we will set up a phone call to discuss your diagnosis with you:
- Copy of the CD of your MRI images,
- Copy of your audiogram (hearing test), and
- Copies of any balance testing (VNG) or auditory brainstem response (ABR) tests.
Acoustic Neuroma Symptoms
Some of the symptoms you experience may occur gradually or suddenly while others may come and go. Consult your doctor if any of these signs or symptoms start to manifest.
Hearing Loss
An acoustic neuroma grows slowly, however, it can eventually begin to push against nerves between your inner ear and your brain. For many patients, the first sign of an acoustic neuroma is hearing loss in one ear, which has typically occurred over time. Some people may also notice a sudden, sharp decrease in hearing.
Tinnitus
Ringing in your ear (also called tinnitus) can be an early sign of an acoustic neuroma. However, many people who do not have a tumor experience tinnitus as well.
Fullness in the Ear
You may experience the feeling of fullness in the ear on the side where the acoustic neuroma is located.
Dizziness and Balance Problems
As the tumor presses on your vestibular nerve (the nerve affecting balance), you may feel dizzy and unsteady. Some people may not notice any balance challenges or dizziness because their body adjusts while the acoustic neuroma grows.
Headache
If your acoustic neuroma grows large enough, fluid can build up in your head (called hydrocephalus) and cause headaches, confusion, and coordination problems. Sometimes acoustic neuroma patients report headaches even when hydrocephalus is not an issue.
Tiredness
Some patients report acute fatigue or exhaustion prior to being diagnosed with an acoustic neuroma.
Other Symptoms
A large acoustic neuroma can push on additional nerves causing numbing or tingling in your face as well as trouble swallowing.
Diagnosing Acoustic Neuromas
We will perform a variety of tests to help determine whether you have an acoustic neuroma. Some of the tests can be performed at your doctor’s office while others may require a visit to a specialist or hospital.
- Hearing tests — An audiologist will check your ability to hear sounds at different volumes and pitches at high and low frequencies. You will listen to a series of beeps and words while wearing headphones.
- Imaging tests — We will look inside your head using magnetic resonance imaging (MRI), which relies on radio waves and magnetic fields. An MRI helps us confirm a tumor diagnosis. You will be injected with a special fluid known as a contrast dye. That dye makes a tumor — if one exists — stand out from healthy brain tissue.
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Acoustic Neuroma Causes
Researchers do not know the cause of acoustic neuromas. However, researchers have found a few things that may be associated with developing this type of tumor.
- Neurofibromatosis type 2 (NF2) — This is a genetic disorder where noncancerous tumors grow in the nervous system. People with this condition have an increased risk of acoustic neuromas in both ears.
- Radiation — High doses of radiation to the face or neck could be linked to an increased risk of getting an acoustic neuroma. No research has definitively linked cell phone use to acoustic neuromas.
Acoustic Neuroma Treatment
Once we have confirmed your diagnosis, you may have several treatment choices depending on the size and location of the tumor, your age, and overall health.
Observation
If your tumor is small and not causing significant problems, we may want to monitor it periodically. You will need to receive periodical scans such as an MRI to determine whether it is growing over time.
We typically recommend this option for older patients or patients whose health makes surgery too difficult.
Radiation
Stereotactic radiation therapy targets the tumor without impacting the surrounding healthy issue to help stop or slow the tumor growth. You may receive one high dose or several lower doses in an outpatient setting. No actual cutting takes place in this procedure. This treatment is tailored to the size and shape of your tumor due to the advances in radiation.
The advantages of radiation treatment include the following:
- you will not lose your hair as a result of the radiation treatment and
- you can usually return to work the day after receiving radiation.
The impact that radiation has on your tumor may not be known for several years. Radiation typically causes you to lose your hearing over time.
Surgery
If surgery is the best way to treat your acoustic neuroma, your doctor will perform a craniotomy, which requires surgeons to temporarily remove a small piece of your skull.
There are three different kinds of craniotomies we can perform:
- Retrosigmoid craniotomy — We will make a incision (cut) behind your ear to access the acoustic neuroma. This approach is often used for smaller tumors and for when your hearing can be preserved.
- Translabyrinthine craniotomy — We also make a cut behind your ear for this procedure. Some of the inner ear bone must be removed for this type of procedure. This approach can cause hearing loss but will often preserve your facial nerves.
- Middle fossa craniotomy — During this procedure, we access your tumor through a incision above the ear. This is another viable option for people with small tumors and also offers the ability to preserve your hearing.
Acoustic Neuroma Recurrence
It is extremely rare for acoustic neuromas to grow back after surgery. We typically perform routine surveillance imaging to watch for a recurrence.
