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Acoustic Neuroma

Acoustic neuromas are a type of tumour that develop on the nerve between the inner ear and the brain. They are benign (noncancerous) and grow slowly but can affect hearing and balance. They develop on the nerve known as the vestibular nerve from cells called Schwann cells. Schwann cells create protective membranes for brain cells, also known as neurons. For this reason, they can also be called vestibular schwannomas.

Symptoms

Common symptoms of an acoustic neuroma are:

  • Ringing in the ear (tinnitus)
  • Loss of balance or dizziness
  • Hearing loss that is usually gradual
  • Facial numbness or weakness

Symptoms of an acoustic neuroma usually take years to show and can be easy to miss. The longer someone has an acoustic neuroma, the more likely they are to notice symptoms that affect not just their hearing, but sensation in the face and ability to move the facial muscles. Acoustic neuromas rarely get big enough to become life-threatening.

Causes & Risk Factors

Acoustic neuromas are linked to genetic mutations on the 22nd chromosome. The 22nd chromosome has a gene that helps regulate the growth of Schwann cells. When that gene is mutated, acoustic neuromas are more likely to occur. This genetic mutation is often inherited as part of a genetic disorder called neurofibromatosis 2. However, most acoustic neuromas have no obvious cause.

The only known risk factor for acoustic neuromas is having a parent with neurofibromatosis 2.

Diagnosis & Complications

A doctor will diagnose acoustic neuroma with a combination of information about your medical history, current and past symptoms, and ear exams.

Some diagnostic tests that may be performed include:

  • Hearing test – known as an audiometry, this test can be performed by a specialised hearing doctor. They’ll play sounds at varying volume levels to determine how low you can hear noise.
  • Imaging tests – a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan can be done to help a doctor see the tumour.

Complications of an acoustic neuroma include permanent hearing loss and tumours large enough that they press on the brain stem. This can cause a buildup of fluid around the brain that can be life-threatening.

Treatment & Management

The treatment of an acoustic neuroma is based on the current size and rate of growth of the tumour, the overall health of the patient, and the current symptoms.

Treatment options include:

  • Monitoring – monitoring an acoustic neuroma may be a good option if it is not growing or if it’s growing slowly. This is often a course of treatment taken when acoustic neuromas exhibit no symptoms, or symptoms that do not affect quality of life. Monitoring can also be suitable for older patients who are not the best candidates for surgery. When monitoring an acoustic neuroma, hearing tests and imaging of the tumour need to occur every 6-12 months to visualise any changes.
  • Surgery – this is a good option if an acoustic neuroma is actively growing, large, and causing symptoms that interfere with someone’s quality of life. Due to the proximity of the nerve the tumour grows from to other nerves that are important to the functioning of the brain and facial muscles, surgery does have potential complications. These include hearing loss, facial weakness or numbness, balance issues, ringing in the ears, headache, meningitis, and rarely, bleeding in the brain or a stroke.
  • Radiation therapy – to treat an acoustic neuroma, targeted radiation therapy is used to affect the small area where the tumour is growing. Radiation may be a good option if the tumour is very small but symptomatic or if one is a little too old to tolerate surgery well.

Supportive care can also be used to treat the symptoms of acoustic neuroma and improve the quality of life of patients living with it.

 
 
 

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