Acoustic neuroma is a benign tumor that affects the vestibular nerve. Although it is benign, it can cause significant discomfort in the affected patient. Therefore, if symptoms such as dizziness, hearing problems or balance disorders occur, an ear, nose and throat specialist should be consulted immediately so that a diagnosis of the cause can be made as early as possible and, if necessary, the acoustic neuroma can be treated as soon as possible.
What is acoustic neuroma?
Acoustic neuroma is a benign tumor that affects the vestibular nerve. The vestibular nerve connects the vestibular organ to the brain. Acoustic neuroma is a benign, slow-growing tumor inside the skull. The benign neurinoma forms from the outer covering of the nerve cells – called Schwann cells – of the vestibular nerve. Because the vestibular nerve has almost the same pathway into the brain as the auditory nerve, when the acoustic neuroma grows, symptoms affecting hearing may also occur. Typically, the neurinoma does not metastasize. Affected individuals often notice acoustic neuroma by the onset of tinnitus, hearing loss or unilateral hearing loss. However, the facial nerve can also be affected by acoustic neuroma, which can also lead to paralysis in the facial area. If the neurinoma continues to grow, there is a risk that it will squeeze the brainstem or cerebellum, which can have serious consequences. Appropriate treatment should be initiated as soon as possible, especially in children and adolescents, to contain the consequences of acoustic neuroma.
Causes
The cause of acoustic neuroma is unknown to scientists and physicians. However, the risk of developing neurinoma increases with age. If acoustic neuroma develops in connection with neurofibromatosis type II, the disease is based on a genetic alteration of the hereditary material. These are responsible for the development of benign tumors of the brain and spinal cord. Indications of neurofibromatosis may include bilateral acoustic neuroma and the occurrence of the disease at a younger age. In addition, a neurinoma may develop in association with radiation of a cancer to the head. Even many years after the cancer is completed, there is a possibility that former irradiated cancer patients will develop acoustic neuroma.
Symptoms, complaints, and signs
Although an acoustic neuroma (neurinoma) is a benign tumor, it can cause significant symptoms. In neurinoma, symptoms are always the result of displacement processes. The tumor itself grows very slowly, but does not form metastases. Thus, the affected person can remain symptom-free for decades, in which case the tumor is often an incidental finding. However, when it reaches a certain size or is located in an unfavorable place, symptoms then occur, depending on which nerves are displaced. Often the first symptom is a slowly increasing unilateral hearing loss. In rarer cases, this begins quite suddenly, as in a hearing loss. This results in repeated hearing loss. In addition to the hearing disorders, balance disorders often occur. As a rule, the hearing disorders are unilateral. However, bilateral hearing loss is rarely observed. The hearing loss may progress to deafness. The balance disorders vary in intensity. Rotational vertigo rarely occurs. More often, sufferers have the sensation that the floor is swaying beneath them. In addition to these frequently occurring symptoms, there are also less common symptoms. When the seventh cranial nerve is displaced, facial paralysis may occur. Taste disturbances and the stoppage of tear production are also possible. Furthermore, the displacement processes can also lead to numbness and pain in the face. In very severe cases, movement disorders, circulatory problems, or respiratory distress occur with possible death.
Diagnosis and course
If a patient is suspected of having an acoustic neuroma, the primary care physician will refer him or her to an otolaryngologist. After a detailed interview with the patient, the ears are examined and an audiogram is performed. With this, the ENT physician checks whether the patient can no longer hear certain frequencies on one or both sides.Another diagnostic option is brainstem audiometry (ABR), which checks the auditory nerves. In addition, the examination provides information about the functional capacity of the brain regions involved in hearing. Both tests usually show results that deviate from the norm in acoustic neuroma. Tests of the sense of balance can also provide information about the presence of a neurinoma. To confirm the suspected diagnosis, the otolaryngologist will order an MRI, or imaging procedure, of the head, on which he or she can reliably detect the acoustic neuroma.
When should you see a doctor?
If one suspects that one is suffering from an acoustic neuroma, a doctor must be consulted immediately in any case. Even if this is a benign tumor, it can cause significant limitations and discomfort in the patient’s life. Medical treatment is essential in this case. The complaint will usually not disappear on its own or heal spontaneously. In this case, the affected person suffers from hearing difficulties or deafness very suddenly. If these complaints occur without any particular reason, a doctor should be consulted immediately. Likewise, treatment is necessary if tinnitus or visual disturbances occur. Furthermore, patients often suffer from loss of balance and facial paralysis. These symptoms can also be a sign of acoustic neuroma. Usually, patients can go directly to the otolaryngologist, who can diagnose and treat the acoustic neuroma. If detected and treated early, the patient’s life expectancy will not be reduced.
Treatment and therapy
There are different treatment options for an acoustic neuroma depending on its location and size. For very small neurinomas that do not cause discomfort to the patient and grow slowly, it may be possible to wait initially in individual cases. Of course, the findings of the acoustic neuroma require constant control and observation in order to notice a progression of the disease as early as possible. The second possibility to treat an acoustic neuroma is surgery. This method is mainly used when the acoustic neuroma has already grown very large and causes considerable discomfort, or when the patient becomes ill at a young age. If the acoustic neuroma is not yet larger than two centimeters, the treating physician often advises irradiation of the benign tumor. All three treatment methods have advantages and disadvantages, which is why the decision to treat acoustic neuroma should be thoroughly considered. It is recommended for patients to seek advice from several ear, nose, and throat physicians to help them determine the most appropriate treatment method for their acoustic neuroma.
Outlook and prognosis
Acoustic neuroma causes various symptoms, which usually occur in the head area of the patient. In this case, the affected person mainly suffers from dizziness and hearing difficulties. It is not uncommon for balance disorders to occur as well, which can negatively affect the daily life of the affected person. The severe dizziness often leads to a loss of consciousness, during which various injuries can occur due to falls. In the worst case, the patient suffers a complete hearing loss due to the acoustic neuroma. For many people, hearing loss is a severe complication, sometimes leading to depression. Furthermore, tinnitus or other ear noises can occur, which reduce the quality of life. Sometimes paralysis occurs in the face and the affected person may continue to suffer from visual disturbances. Blindness does not usually occur. In many cases, the hearing damage relates only to certain frequency ranges. In most cases, acoustic neuroma is treated surgically and usually leads to a positive course of the disease. Furthermore, radiation of the tumor can also take place. The patient’s life expectancy is not affected by acoustic neuroma.
Prevention
Unfortunately, since acoustic neuroma is one of the tumor diseases, there is no known effective prevention. Only an attempt can be made to keep the body as fit and healthy as possible through a healthy lifestyle and sufficient exercise. Since acoustic neuroma is a familial disease, the children of affected patients should be examined as early as possible in order to detect the development of an acoustic neuroma as soon as possible.
Aftercare
Acoustic neuroma requires weeks of follow-up care. Therefore, the tumor should not necessarily be operated on far from home. The regular trips there and back must remain manageable for the affected person. Surgical removal of the acoustic neuroma is still the most effective treatment option. Apart from the surgical risks associated with operations in and on the head, the postoperative prospects of recovery are quite good. The more modern the surgical procedures used and the better the follow-up care, the sooner the patient can be discharged as cured. His full quality of life can be regained for the most part by experienced surgeons. Preliminary examinations and aftercare should remain in one hand if possible. It has become established knowledge that the surgeon has gained the best knowledge about the patient’s acoustic neuroma through the preliminary discussions, the preliminary examinations as well as the later operation itself. In addition, he can adapt his surgical strategy to the actual findings at any time during the operation. The goal is to achieve the best possible surgical result. Complete tumor removal is particularly successful with small acoustic neuromas. Larger neurinomas must be removed piece by piece. They involve greater surgical risks. Follow-up visits are designed to keep track of problems that often occur postoperatively. These include dizziness and balance problems, deafness, or surgery-related facial paralysis. The latter requires physical therapy during follow-up. Later follow-up appointments can be handled by a neurologist in the patient’s home town.
What you can do yourself
Acoustic neuroma can develop over years or even decades. By the time the condition is diagnosed, permanent damage such as balance problems or hearing loss has often already developed. Medical treatment, which usually focuses on surgical procedures and regular progress monitoring, can be supported by sparing. Mentally demanding tasks often represent too great a strain and should be reduced if possible if they are associated with a risk of accident. Thus, a change of occupation may be necessary if the condition makes the ability to reliably perform the particular activity impossible. Patients should consult with the appropriate physician and may also need to consult a therapist. If acoustic neuroma is detected early, often no further action is necessary. A simple surgical procedure, after which patients must take it easy, is sufficient for a complete recovery. Nevertheless, those affected should watch for unusual symptoms and have regular routine examinations. If physical discomfort develops after surgery or hearing problems do not subside, various aids such as a hearing aid may also need to be organized.
