December 14, 2020

Acoustic neuroma treatment and hearing preservation

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This benign brain tumor affects roughly 3,000 people in the U.S. each year and can affect hearing and balance. Here’s what you need to know about acoustic neuroma treatment options.

An acoustic neuroma, also known as a vestibular schwannoma, is a benign tumor that grows on the nerve connecting the inner ear to the brain. Because of its location, this tumor can often cause hearing loss and other neurological problems, said Peter J. Morone, M.D., an assistant professor of Neurological Surgery at Vanderbilt University Medical Center and a provider with the Vanderbilt Skull Base Center. And while the word “tumor” can be scary for patients to hear, it’s important to understand that vestibular schwannomas are mostly noncancerous and slow growing.

“These tumors arise from the nerve connected to the brain and only cause problems when they push on surrounding structures,” Morone said. “They usually do not spread within the brain or to other parts of the body.” 

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If you’re living with symptoms like ringing in the ear and hearing loss, it could be due to a rare, benign tumor. Learn more here.

Types of Acoustic Neuromas

There are two different kinds of acoustic neuromas. The majority are sporadic, meaning they occur spontaneously without any known cause. However, a smaller category — around 3-5% of acoustic neuromas — are associated with a syndrome called neurofibromatosis type II (NF2), which is a genetic, inherited disorder characterized by the growth of noncancerous tumors in the nervous system. NF2 is a rare cause of these tumors, but it often causes hearing loss in both ears in patients before the age of 30.

“We don’t know what causes acoustic neuromas to develop,” said Kareem Tawfik, M.D., an assistant professor of Otolaryngology (Head and Neck Surgery) at Vanderbilt University Medical Center.  “We do know that the tumors are composed of Schwann cells, a special kind of cell that envelops nerves and helps transmit electrical impulses. In acoustic neuroma, the Schwann cells of the balance nerve, or vestibular nerve, become overactive and multiply unchecked. That’s why they’re also known as vestibular schwannomas.”

Symptoms and Diagnosis

Signs and symptoms of acoustic neuroma are often subtle and may take years to develop. Common symptoms include:

  • Hearing loss that’s more pronounced on one side
  • Ringing in the ear
  • Unsteadiness or loss of balance
  • Dizziness
  • Facial numbness or weakness

“The most common symptom leading to diagnosis is hearing loss that’s worse in one ear, sometimes accompanied by ringing in the affected ear or imbalance. It can also be an incidental imaging finding that’s picked up during evaluation of an unrelated problem,” Tawfik said. “There are many patients who have an acoustic neuroma but don’t experience any of the common symptoms.”

Treatment Options

“When evaluating a patient for surgery, we always consider completing a hearing-preservation approach if the patient has good hearing.”

Treatment for acoustic neuroma can vary, depending on the size and growth of the tumor and your symptoms. If you have a small growth that isn’t causing symptoms, your doctor may opt to simply monitor the growth with regular imaging and hearing tests. If the scans show the tumor is growing or if the tumor causes progressive symptoms, you may need to undergo treatment.

“If treatment is needed, we use a team-based approach to develop a personalized plan for each individual patient, taking into account a patient’s hearing status, tumor size and tumor location,” said Morone. “For some patients, radiation is the best option, while for others we recommend surgery.”

If surgery is recommended, multiple options exist, such as the middle fossa approach or the retro-sigmoid craniomity, which both preserve hearing, and the translabyrynthine craniomity, which does not. “When evaluating a patient for surgery,” Morone said, “we always consider completing a hearing-preservation approach if the patient has good hearing.”

When it comes to acoustic neuroma treatment, there’s no one-size-fits-all treatment plan, Tawfik said.

“Vanderbilt has a long history of being a center of excellence in the care of acoustic neuroma.  As one of the highest-volume acoustic neuroma programs in the country, we have a great depth of experience in all treatment modalities and hearing preservation techniques. It’s that type of nimble, multidisciplinary care that sets Vanderbilt apart.”

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The Vanderbilt Skull Base Center treats tumors and non-tumor conditions in or around the skull base, the area deep behind your eyes and nose. The center’s team of doctors and other professionals, including our patient care coordinator, have the expertise and experience required to deliver the care you need and provide the compassion you want.

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