Hearing loss can be a part of aging, but sometimes it can be caused by a more serious issue like an acoustic neuroma.
Dr. Oghalai explains the most important things you need to know about acoustic neuromas.
What is acoustic neuroma?
An acoustic neuroma, more correctly called a vestibular schwannoma, is the second most common tumor inside the head. It originates from the sheath of the balance nerve. They are usually slow growing and account for approximately 7.5% of brain tumors.
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How do you get it?
The cause of acoustic neuroma is not well understood. For most acoustic neuromas, the cause at the level of the cellular machinery is the failure of a “governor” gene to exert its effect in suppressing the growth of Schwann cells — those cells responsible for coating nerve fibers with insulation. The result is “wart-like” growth of these cells to produce the neuroma.
The only environmental exposure that has been definitively associated with an increased incidence is radiation exposure to the head. No evidence currently exists for an association between cell phone use and the development of these tumors.
For the most part, it is not an inherited disease, however 5% of cases are associated with a genetic disorder called neurofibromatosis type 2. The vast majority of tumors are sporadic (nonhereditary).
Symptoms can be associated with the size of the tumor, but this is not always consistent. The most common first symptom is one-sided hearing loss and ringing or fullness in the ear. Individuals may also experience balance issues, dizziness and numbness or tingling on one side of their face.
When to consider treatment
If you have been diagnosed with an acoustic neuroma, the most important thing is to first consult with a highly experienced program that can assess your unique needs and identify the care plan that is right for you. This is based on multiple factors such as tumor size, existing level of hearing, symptoms and age. After a thorough review of your individual case with an acoustic neuroma expert, you can then make an informed decision on how to treat your tumor.
The goal of treatment is to stop the degeneration of surrounding cranial nerves. If you are a candidate for hearing preservation, the goal is to preserve your hearing to the level it is at when you are first diagnosed, but it does not recover your hearing to a prior state. Additionally, our top priority is always on maintaining facial nerve function and drastically minimizing the need for any future treatment.
Depending on the size of the tumor, the age and medical condition of the patient, various procedures may be done.
Surgery is performed in an operating room where our skull-base surgical team uses the latest microsurgical approaches and equipment. There are three main microsurgical approaches for the removal of an acoustic neuroma. The approach used for each individual patient is based on factors such as tumor size, location, skill and experience of the surgeon. The surgeon and the patient should thoroughly discuss the reasons for a selected approach.
With radiosurgery, the goal is to stop the growth of your tumor without injuring important structures around the tumor. This does not lead to removal of the tumor, but may potentially stop further growth or shrink it over time. At Keck Medicine of USC, we use state-of-the-art technology to perform these radiation treatments. Radiosurgery is generally reserved for tumors under 2.5 cm in diameter. For young, healthy candidates with active lifestyles and a desire to preserve their hearing, we typically recommend surgery as opposed to radiation.
Watch and Wait or Observation
A “watch and wait” strategy can be a good start for you if your tumor is small and you are experiencing very minimal symptoms. This approach generally involves a second MRI in six months and annually provided there is no growth, and /or symptoms have not changed.
Surgery to remove an acoustic neuroma will take up most of the day. Afterward, the patient will stay in the Intensive Care Unit (ICU) one night so that they can be closely monitored. The next day, the patient will usually be transferred to a regular room. If needed for balance problems after surgery, physical therapy will be ordered to help the patient get up and walk around. Some people need to use a walker after surgery to help prevent falls.
Patients are considered safe to go home when they are:
- Steady on their feet
- Eating and drinking fluids without vomiting
- Not experiencing extreme dizziness
- Controlling their pain
- Experiencing no complications
This can be anywhere from 2-6 days, but 4 days is our average.
Some people have weakness of half their face after surgery. This can occur immediately or have a delayed onset by a few days. If a patient has this, we will provide lubricating eye drops for the patient to use every 1-2 hours during the day. At night, we will provide lubricating eye ointment for the patient to apply and we will teach the patient how to tape their eye shut so it does not get dried out, red or scratched.
After surgery, it is normal to have some pain, discomfort, headaches, tiredness, dizziness, feelings of being off balance and weak. The patient will have some difficulty focusing while reading or on the computer, and will likely need frequent breaks. This may last several weeks to several months.
Try to stay as active as possible. However, the patient should not bend over, exert yourself, or lift anything heavy for at least one month after surgery.
If you have hearing loss or ringing of the ears, make an appointment with a neurotologist. To learn more about USC Acoustic Neuroma Center, visit www.acousticneuroma.keckmedicine.org.
To schedule an appointment, call (800) USC-CARE (800-872-2273) or visit https://acousticneuroma.keckmedicine.org/request-an-appointment/