Acoustic Neuroma

An acoustic neuroma is the most common skull base tumor involving the ear. It is benign (not cancerous) and usually forms on the balance nerve, the eighth cranial nerve. This nerve carries hearing and balance sensation from the ear to the brain. It runs next to the facial nerve and the blood supply to the inner ear. Larger tumors may cause compression of the brainstem, which can lead to significant neurological problems.

Acoustic neuromas most commonly present in adults in their 40s and 50s. Most of these tumors are caused by a genetic defect in the balance nerve. For many patients with an acoustic neuroma, hearing loss in one ear is the first symptom. Other symptoms may include ear noise (tinnitus), imbalance, facial tics or spasm, or other cranial nerve and neurologic issues.

Hearing loss is usually gradual. Balance problems and dizziness are common, but are typically mild. If the tumor gets larger than one inch in size, about half of these patients have numbness on one side of the face. Large tumors can obstruct the flow of spinal fluid, triggering headaches in some individuals.

A hearing test may detect initial symptoms, but an MRI can pinpoint the presence of a tumor. Small tumors in elderly patients may not grow; in these cases, observation without removing the tumor may be considered.

For younger patients, however, other options may be considered, as well. Several surgical procedures may be considered, each using a surgical microscope. Radiotherapy is also an option; it does not remove the tumor, but can impede its growth. Both of these options, surgery and radiotherapy, have complication risks. The best choice can be made only after careful evaluation by a neurotologist.

Physical therapy can be effective to assist with management of symptoms of acoustic neuroma and in the post-surgical phase of recovery to allow compensation and retraining of the balance system.