Everything you need to know about – Acoustic Neuroma
Introduction to Acoustic Neuroma
We see people often suffering from problems like a headache and loss of hearing with no idea of the proper reason for its occurrence. Many times they ignore and take normal medication for pain relief.
But it should not be ignored and left alone without proper treatment because it can happen due to Acoustic neuroma, a benign tumor that develops on the main (vestibular) nerve leading from your inner ear to your brain and affects the hearing and balance nerves.
What is an Acoustic Neuroma?
Acoustic neuroma is a noncancerous tumor which spreads or grows slowly from excess production of Schwann cells also called as a Vestibular Schwannoma. Schwann cells usually wrap around and support nerve fibers. It becomes a large tumor presses on the hearing nerves in the inner ear, facial nerve, nearby blood vessels or brain structures.
How common is acoustic neuroma
This rare disorder is occurring with the increasing incidence that often affects middle-aged people. However, these tumors do not display any defined growth pattern. It is normally uncommon and sporadic in nature and often occurs in both the ears.
Some scientists are of the view that the high doses of radiation and the nerve damage caused by environmental factors may lead to Acoustic neuroma.
Types of acoustic neuromas
There are 2 types of acoustic neuromas, they are
- Unilateral acoustic neuromas
- Bilateral acoustic neuromas
Unilateral acoustic neuromas: It is the most common type of acoustic neuroma. This type of acoustic neuromas affects only one ear. This tumor may develop at any age but mostly it happens in the persons who are above 60 years.
Bilateral acoustic neuromas: It is caused by a genetic problem called neurofibromatosis-2 (NF2). This type of acoustic neuromas affects both ears and is inherited.
Causes of Acoustic Neuroma
Find here what causes acoustic neuroma. There is no particular cause for Acoustic neuroma. The following are some of the possible reasons for Acoustic neuroma:
- Malfunctioning gene on chromosome 22.
- Continuous listening to loud noise like music or work-related noise.
- Genetic disorder
- nerve damage caused by environmental factors
- Neck or face radiation can lead to acoustic neuroma many years later.
- People who have a disease called neurofibromatosis type 2 (NF2) are at higher risk. NF2 can run in families.
Signs & Symptoms of Acoustic Neuroma
Signs and symptoms of acoustic neuroma develop from the tumor pressing on cranial nerves and are often subtle. It may take many years to develop. As the tumor grows, more noticeable or severe signs and symptoms may be seen. Some common signs and symptoms of acoustic neuroma include:
- Hearing loss: One of the first symptoms that occur is hearing loss on only one side or more pronounced on one side.
- Ringing in the affected ear [tinnitus]: over 80 percent of patients will also have tinnitus or ringing in the affected ear.
- Dizziness, Loss of balance or unsteadiness: The person may faint and lose balance if the tumor affects the inner ear.
- Earache: There may be an earache in some cases.
- Facial numbness and tingling: You will also experience symptoms like Facial numbness and tingling.
- Loss of sensation: Due to a large tumor develops and compresses a part of the brainstem, local cranial nerves may be effected and lead to loss of sensation on one side of the face and mouth. In this case, the back half of the tongue may lose its sense of taste.
- Headaches, clumsy gait, and mental confusion: larger tumors can increase the pressure in the head and leads to headaches, vomiting, and altered consciousness.
- Temporary blurred or double vision: In rare cases, vision problems occur.
- A hoarse voice or difficulty swallowing: Because of these tumors, it will be difficult to talk and swallow food.
- Vision issues: In some rare cases vision problems occur.
The symptoms of acoustic neuroma may look like other health problems such as Ménière’s disease also have similar symptoms. So, if you experience any of these symptoms in you or your loved ones, it’s important to speak to your doctor or nearby ENT specialist. He/she will check for an acoustic neuroma give treatment appropriately. Hoping you got more about acoustic neuroma symptoms signs.
Acoustic neuroma early symptoms
- The early symptoms of an acoustic neuroma may include:
- Impaired hearing in the affected ear
- A ringing or buzzing sound in the ear, known as tinnitus
- Difficulties with balance
- In some cases, facial numbness
- A sensation of fullness or blocking in the affected ear.
Acoustic neuroma advanced symptoms
Symptoms of advanced acoustic neuroma can include:
- Headache
- Pain in the face
- Facial numbness
- Facial twitches
- Visual disturbances, such as double vision
- Difficulties swallowing
- Eventual death as the functioning of the brain stem is impaired.
Symptoms of acoustic neuroma in adults
- Hearing loss that usually only affects one ear
- Tinnitus (hearing sounds that come from inside the body)
- Vertigo (the sensation that you’re moving or spinning)
- Persistent headaches
- Temporary blurred or double vision
- Numbness, pain or weakness on one side of the face
- Problems with limb coordination (ataxia) on one side of the body
- A hoarse voice or difficulty swallowing
Diagnosis of Acoustic neuroma
It is often difficult to diagnose Acoustic neuroma at its early stages because the signs and symptoms of Acoustic neuroma are subtle and develop gradually over time. After asking questions about your symptoms, the doctor will conduct an ear exam and may order the following tests:
Hearing test (audiometry): Hearing specialist (audiologist) conducts a hearing test where you hear sounds directed to one ear at a time. The audiologist asks you to indicate each time you hear the sound by presenting a range of sounds of various tones and each tone is repeated at faint levels to find out when you can barely hear. He audiologist may also present various other words to determine the hearing ability of your ears.
Imaging: The main test preferred to confirm the presence of acoustic neuroma is Magnetic resonance imaging (MRI) as it is the imaging test which can detect tumors as small as 1 to 2 millimeters in diameter. If MRI is unavailable, computerized tomography (CT) may be used, but it can miss very small tumors.
Treatment
Acoustic neuroma treatment may vary, depending on the size and growth of the acoustic neuroma because overall health and the symptoms you’re experiencing may vary from one person to another person. Your doctor may suggest one or more of three potential treatment methods for treating Acoustic neuroma. These methods include monitoring, surgery or radiation therapy.
Monitoring
Acoustic neuroma specialist may decide to monitor Acoustic neuroma if you have a small acoustic neuroma that isn’t growing or is growing slowly and causes few or no signs or symptoms. Especially this will be advised if you’re an older adult or otherwise not a good candidate for more-aggressive treatment.
You may have to undergo regular imaging and hearing tests, usually every six to 12 months in order to determine whether the tumor is growing and if how quickly. You may need to undergo treatment if the scans show the tumor is growing or if the tumor causes progressive symptoms or other difficulties.
Surgery
You may need surgery to remove an acoustic neuroma and your surgeon may use one of several techniques for removing an acoustic neuroma, depending on the size of your tumor, hearing status and other factors.
The entire tumor may not be able to be completely removed in certain cases because if the tumor is too close to important parts of the brain or the facial nerve. In certain cases, surgical removal of the tumor may get affect other symptoms if the hearing, balance or facial nerves are damaged during the operation.
Complications may include:
- Leakage of cerebrospinal fluid through the wound
- Hearing loss
- Facial weakness
- Facial numbness
- Ringing in the ear
- Balance problems
- Persistent headache
- Infection of the cerebrospinal fluid (meningitis)
- Stroke or brain bleeding
- Radiation therapy
- Gamma Knife stereotactic radiosurgery
- Gamma Knife stereotactic radiosurgery
Stereotactic radiosurgery: Stereotactic radiosurgery, such as Gamma Knife radiosurgery, uses many tiny gamma rays to deliver a precisely targeted dose of radiation to a tumor without damaging the surrounding tissue or making an incision. Your doctor pinpoints the tumor and then plans where to direct the radiation beams using imaging scans.
The doctor attaches a lightweight head frame to your numbed scalp so as to keep your head still during the procedure. This surgery is done to stop the growth of a tumor, preserve possibly preserve hearing and the facial nerve’s function.
Your doctor with follow-up imaging studies and hearing tests will monitor your progress which may take weeks, months or years before the effects of radiosurgery become evident.
Stereotactic radiotherapy: Fractionated stereotactic radiotherapy (SRT) curbs the growth of the tumor without damaging surrounding brain tissue delivering a small dose of radiation to the tumor over several sessions.
Proton beam therapy: This type of radiation therapy treat tumors and minimize radiation exposure to the surrounding area by using the high-energy beams. These beams are positively charged particles called protons which are delivered to the affected area in targeted doses.
Supportive therapy
Your doctor may recommend supportive therapies to address symptoms or complications of an acoustic neuroma such as dizziness or balance problems in addition to treatment to remove or stop the growth of the tumor. Your doctor may also recommend other treatments like Cochlear implants may also be recommended to treat hearing loss.
What you can do?
- Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Make a list of all medications, vitamins or supplements that you’re taking.
- Ask a family member or friend to join you, if possible. Because the information provided to you during an appointment has to be remembered and this is difficult to remember for a person undergoing treatment. Bring a person who accompanies you because you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Questions for Acoustic Neuroma Specialist:
- Are you a comprehensive center which provides all three forms of tumor management (observation, radiation, and surgery)?
- Will you provide all three surgical approaches?
- Is there a team approach with a board-certified neurotologist and neurosurgeon?
- How many surgeries you have undergone in your career?
- Will I regain my lost hearing?
- What is the recovery process like?
- What is likely causing my symptoms?
- Are there any other possible causes for my symptoms?
- What kinds of tests do I need?
- What treatment options are available?
- Which one do you recommend for me?
- What is the likelihood of side effects from each treatment option?
- What happens if I do nothing?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
Acoustic Neuroma Prognosis
Acoustic neuroma is not malignant due to which it has goa od prognosis. Small tumors may not even require any surgery because they does not spread to other parts of the body. It can compress the other structures because of increases in size, that may lead to serious conditions:
- Permanent deafness
- Permanent facial nerve affectation leading to paralysis of the facial nerves
- Hydrocephalus as a result of obstruction of cerebrospinal fluid
- Increase in intracranial pressure
The hearing ability of a patient cannot be returned even after the surgery. When symptoms occur such as gradual hearing loss and gait problems one should contact a medical provider for early detection and management of acoustic neuroma.
Complications of acoustic neuroma
An acoustic neuroma sometimes causes permanent complications and surgical removal of the tumor may improve the symptoms if the facial nerves like hearing and balance nerves are damaged during the operation.
The complications of an acoustic neuroma include
- Facial numbness and weakness
- Hearing loss
- Difficulties with balance
- Ringing in the ear
- Infection of the cerebrospinal fluid (meningitis)
- Stroke or brain bleeding
- Persistent headache
- Leakage of cerebrospinal fluid from the wound
- Tumors may press on the brainstem
- Opposes the normal flow of fluid between the brain and spinal cord (cerebrospinal fluid) where excess fluid can build up in your head (hydrocephalus)
- Increase the pressure inside your head
Risk Factors of Acoustic Neuroma
Though there are a number of potential risk factors of Acoustic neuroma, researchers are still not sure about the exact cause of acoustic neuromas and no environmental factor like diet or cell phone use has been proven as a cause or risk factor.
Acoustic neuroma risk factors
The American Nurses Association (ANA) recommend that frequent cell phone users use a hands-free device to keep the cell phone farther from the head. The risk factors include:
- Having the rare genetic disorder neurofibromatosis 2.
- Staying in Loud noisy places for a long time.
- Exposure to a low level of radiation.
- Chronic cases cause hydrocephalus.
- middle-aged person
Acoustic neuroma homeopathic treatment
Homeopathic remedies like Chinese herbal medicines and acupuncture are used to control pain and headaches associated with the neuroma. These methods are considered to be good for hearing restoration and also to control facial paralysis. However, there is no scientific evidence to support the effectiveness of these methods. Turmeric supplements are considered to be effective in preventing the growth of the tumor.
Acoustic neuroma natural treatment
The first thing to consider for an acoustic neuroma is that if it is a slow-growing, benign tumor, and you’re fairly certain it’s not cancer, the most natural treatment option would be to observe it.
In terms of natural treatments for the symptoms of acoustic neuromas, such as ringing in the ears and balance, it is important to minimize the amount of stress in your life. Sometimes different hearing aids can assist with hearing loss and elevate the hearing in the ear on the same or opposite side. They can also help with tinnitus by blocking out different sounds to help with the ringing. But usually, it’s not a very good option.
Overall in terms of hearing, natural treatments include acupuncture, massage, yoga, meditation, and prayer. They will certainly help to reduce the amount of stress associated with having a brain tumor
Acoustic neuroma surgery success rate
Every patient’s outcome during acoustic neuroma surgery depends on several individual factors, such as health condition and age. However, it is possible to make generalizations based on the results of previous patients’ experiences.
In a study of 2,000 patients, 20% of patients did not undergo treatment immediately and instead of undergoing surgery they were monitored closely for tumor growth. Of those patients, approximately 15% of patients ultimately required acoustic neuroma treatment.
In the same study of 2000 patients, 61% of patients underwent surgery, and 20% received radiation therapy. Tumor growth control (shrinkage or absence of growth) is achieved in 95-100% of cases for patients who undergo stereotactic radiosurgery.
in general success rates may be higher in some patients than others and they may experience greater relief from symptoms and require less or no retreatment. This is frequently found in patients who are younger with smaller tumors and/or fewer complicating health conditions.
However, your doctor will consider all the factors relating to an individual, and if he or she has recommended acoustic neuroma surgery. Your surgery is anticipated to have a positive treatment outcome because the doctor has determined the potential benefits outweigh any potential risks of an individual.
Acoustic neuroma surgery cost
India offers for various medical and health-related problems and is widely popular for the low-cost treatment.
in India, some of the best hospitals barely charge half the amount charged by hospitals of US, UK, and other developed countries due to which the cost of Acoustic Neuroma surgery in India is lower.
Usually, people from such developed countries travel to India in order to avail such affordable treatment options, which may be an impossible dream in their own country. Even travel and accommodation is very reasonable in India with world-class hotels and travel services.
However Low-cost does not affect the quality of service offered by hospitals and medical professionals because they do not compromise on quality care and this has satisfied much medical care- seekers from all around the globe.
Investigations for Acoustic Neuroma
There are several types of investigations for Acoustic Neuroma that may have a series of tests to establish whether it is your hearing nerves that are the cause. These tests help to examine your head and can provide images that confirm the presence of an acoustic neuroma. Some of them are:
- Audiogram
- Gadolinium-enhanced MRI head
- CT head
- Auditory brainstem reflexes
Hearing test (audiometry): Generally the first test performed to diagnose acoustic neuroma is the test of hearing to measure how well the patient hears sounds and speech. The patients are asked to hear some sounds and speech while wearing earphones attached to a machine that records responses and measures hearing function.
The audiogram shows the increased “pure tone average” (PTA), increased “speech reception threshold” (SRT) and decreased “speech discrimination” (SD).
Brainstem auditory evoked response (BAER): This test is performed to provide information on brain wave activity as a response to clicks or tones. The patient wears electrodes on the scalp and earlobes and earphones to listen to these sounds. These electrodes record the brain’s response to these sounds.
A magnetic resonance imaging (MRI): It helps to produce a detailed picture of the inside of your head using strong magnetic fields and radio waves.
Computerized tomographies (CT) scan: It generates a detailed image of the inside of your head using a series of X-rays to. If an acoustic neuroma is present, the tumor will appear differently than normal brain tissue and appear clearly on the scan.
Self- care for Acoustic Neuroma
Treatment of acoustic neuroma may not always give perfect results. Occasionally, you struggle with most symptoms like tinnitus, dry eye, and risk of corneal injury, one-sided hearing loss, and sometimes even facial paralysis.
Know the possible solutions and treatment options for your problem of acoustic neuroma with a clear mind and discuss it with your family members and choose the best option.
The challenges caused by acoustic neuroma may create a depression in you. So, always maintain a positive attitude and look forward to what you can do with acoustic neuroma. Accept the situation and look for the best options available in such situations.
- Use the proper aids to overcome acoustic neuroma restrictions.
- After the treatment, hearing loss does not get better immediately. So use hearing aids to be able to hear clearly.
- Use a walking stick to maintain your body balance and walk steadily.
- Seek the advice of an occupational therapist to live more independently.
Treatment for Acoustic Neuroma
Treatment for acoustic neuroma can include watching and waiting, surgical removal or radiation. If you are diagnosed with an acoustic neuroma, your acoustic neuroma treatment will depend on a number of things, including:
- Your age
- Your general health and health history
- How sick you are
- Your opinion or preference for treatment
- the size of the tumor
- the place of the tumor
- Results of other tests.
- Can you handle specific medicines, procedures, or therapies
- How long the condition will last
There’s no need to rush into a decision regarding treatment because Acoustic neuromas grow very slowly. It is good to consider all the options carefully and discuss them with the surgeon in detail.
Acoustic neuroma treatment
All treatments for acoustic neuroma are done in specialist centers and the surgery is performed under general anesthesia. It involves removing the tumor through the inner ear or through a window in your skull.
But in some cases, it is difficult to remove the entire tumor if the tumor is too close to important parts of the brain or the facial nerve. The treatments include:
- observation
- microsurgery
- radiotherapy
- radiosurgery
Some of the acoustic neuroma treatments will have side effects like surgery and radiosurgery can sometimes cause facial numbness or paralysis. It’s important to speak to the doctor about the best option for you and what the risks and benefits.
Medical advice for Acoustic Neuroma
You may not need any treatment if the tumor is small in size. However, you require proper medical treatment if your tumor is growing larger. Seek medical aid as soon as you experience symptoms of acoustic neuroma.
Early diagnosis of an acoustic neuroma may prevent the tumor from growing large and help to escape from the serious consequences such as total hearing loss or life-threatening damage to the blood vessels within your skull through the production of fluid.
What you can expect from your doctor?
Acoustic Neuroma Specialist may ask you a number of questions. The following are the questions which your doctor may ask you
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Do you have any family members with an acoustic neuroma?
- At its current level, do you feel the hearing in the affected ear is useful to you in any way? For example, can you use that ear on the telephone, or does that ear help you tell where the sound is coming from?
- Do you have regular headaches currently or have you had them in the past?
Possible post-treatment issues following acoustic neuroma surgery
Possible post-treatment issues include:
- Hearing loss in the involved ear – as a result of the surgery to remove the tumor
- Tumor re-growth
- Cerebrospinal fluid leaks
- Infection of the cerebrospinal fluid (meningitis)
- Tinnitus
- Dizziness, balance problem
- Facial nerve weakness
- Headaches
- Dry eyes, double vision, inability to close the eyelid
- Taste disturbance, dry mouth, swallowing difficulties
- Brain bleeding and swelling
- Seizures
Fast facts on acoustic neuroma
- Acoustic neuroma is a benign tumor that affects the inner ear.
- Common symptoms include hearing loss and tinnitus.
- There are many treatment options, including surgery.
FAQs of Acoustic Neuroma
When to see your doctor?
See your doctor when you notice
- Hearing loss in one ear
- Ringing in your ear
- Trouble with your balance
Can an acoustic neuroma be life-threatening?
In rare cases, an acoustic neuroma may grow large enough to compress the brainstem and become life-threatening by forming fluid within your skull effects the normal functioning of your body.
How to prevent a tumor from growing?
Taking early treatment of an acoustic neuroma may help keep the tumor from growing large and will help to escape from the risk of causing serious consequences, such as total hearing loss, improper neurological function etc.
What are the problems caused by acoustic neuroma?
Acoustic neuroma can cause problems like the Hearing loss, particularly in one ear, or develop ringing in your ear, dizziness or have trouble with balance.
Is there any risk of getting permanent hear loss?
Acoustic neuroma tumor becomes larger and presses on your balance and hearing nerves. Then you get hearing problems. It can be temporary or permanent depending on the severity of the problem.
Can acoustic neuroma cause cancer?
It is non-cancerous and it doesn’t spread around the body. If it’s completely removed, it may not grow back again.
Can acoustic neuroma be inherited?
The overgrowth of the tumor may be caused by an inherited disorder, called neurofibromatosis type 2.
What might be the treatment for acoustic neuroma?
Treatment can be varied depending on the size and growth of the acoustic neuroma, symptoms, and your personal preferences.
How common are acoustic neuroma?
It is estimated that nearly 3.5 people out of every 100,000 develop acoustic neuroma and 5,000 new cases are identified each year. The number of acoustic neuroma cases is rising and this condition is becoming more common.
Are there any complications with acoustic neuroma?
An acoustic neuroma may cause permanent complications which include Hearing loss, Facial numbness and weakness, Difficulties with balance, ringing in the ear.
What is the cause of acoustic neuroma?
Unfortunately, there is no clear cause for an acoustic neuroma and they tend to effect people aged 30-60 years of age.