Acoustic neuroma and its treatment in Türkiye

An acoustic neuroma (vestibular schwannoma) is a rare noncancerous tumor. It grows slowly from an overproduction of Schwann cells and is also called a vestibular schwannoma. The tumor then presses on the hearing and balance nerves in the inner ear. Schwann cells normally wrap around and support nerve fibers. A large tumor can press on the facial nerve or structures of the brain.

What are the types of acoustic neuroma?

Unilateral acoustic neuroma.

This type affects only one ear. It is the most common type of acoustic neuroma. This tumor may develop at any age. It most often occurs between the ages of 30 and 60. Acoustic neuroma may be the result of nerve damage caused by environmental factors. No environmental factor has been shown to cause acoustic neuromas.

Bilateral acoustic neuromas.

This type affects both ears and is inherited. It is caused by a genetic problem called neurofibromatosis-2 (NF2).

What are the causes of acoustic neuroma?

Painful radiation to the face or neck can lead to acoustic neuroma after many years. People with a disease called neurofibromatosis type 2 (NF2) are also at a higher risk. NF2 can run in families.

What are the symptoms of an acoustic neuroma?

These are the most common symptoms of an acoustic neuroma:

• Hearing loss on one side, high frequency sounds cannot be heard
• Feeling of fullness in the ear
• Ringing in the ear (tinnitus) on the side of the tumor
• Dizziness
• Balance problems or unsteadiness
• Facial numbness and tingling with possible, albeit rare, paralysis of the facial nerve
• Headache, clumsy gait, and mental confusion

The symptoms of an acoustic neuroma may look like other health conditions or problems. Always speak with your healthcare provider for a diagnosis.

How is an acoustic neuroma diagnosed?

Because the symptoms of these tumors are similar to other middle and inner ear conditions, they can be difficult to diagnose. Initial diagnostic procedures include an ear examination and a hearing test. Computed tomography (CT) and magnetic resonance imaging (MRI) scans help to determine the location and size of the tumor. Early diagnosis provides the best chance for successful treatment.

Diagnosis includes:

• Hearing test (audiometry): This is usually a test of hearing function, which measures how well a patient hears sounds and speech. The first test performed to diagnose acoustic neuroma. The patient listens to sounds and speech while wearing earphones connected to a device that records responses and measures hearing function. The audiogram may show increased “pure tone mean” (PTA), increased “speech reception threshold” (SRT) and decreased “speech discrimination” (SD).
• Auditory Brainstem Evoked Response (BAER): This test is done in some patients to provide information about brain wave activity in response to clicks or tones. The patient listens to these sounds while wearing electrodes on the scalp, earlobes, and earphones. Pick up the electrodes and record the brain’s response to these sounds.
• Head examinations: If other tests show that the patient may have an acoustic neuroma, magnetic resonance imaging (MRI) is used to confirm the diagnosis. An MRI uses magnetic fields and radio waves, rather than X-rays, and computers to create detailed pictures of the brain. It shows optical “slices” of the brain that can be combined to create a 3D image of the tumor. A dye is injected into the patient. In the case of an acoustic neuroma, the tumor will absorb more dye than normal brain tissue and will show up clearly on examination. MRI generally shows a densely ‘enhanced’ (bright) tumor in the internal auditory canal.

What is the treatment for acoustic neuroma?

Choosing the right treatment depends on a number of factors, including:

• Tumor size
• Whether the tumor is growing
• The age
• Other medical conditions you may have
• The severity of your symptoms and their impact on your life

These tumors can often be completely removed with surgery. However, many are so small that they may not need immediate treatment.

Treatment of acoustic neuromas depends on the size of the tumor, the patient’s age, general health, and preferences, and may include surgery, radiosurgery, and sometimes observation.

Surgeons have developed several types of craniotomy to remove acoustic neuromas. Surgical craniotomy may use a subcranial approach, a semi-cephalic approach or a fossa  approach.

• Keyhole brain surgery (retrosigmoid craniotomy)
• Localized craniotomy

Surgery for large tumors is complicated by possible damage to hearing, balance, and facial nerves. Another treatment option is radiosurgery, which uses carefully focused radiation to reduce the size of a tumor or limit its growth.

For patients with smaller acoustic neuromas, surgery and radiotherapy are equally effective. Doctors may also recommend radiation therapy to treat older patients.

• Radiosurgery: Radiosurgery treatments can be single or piecemeal (multiple smaller treatments instead of one large one). Fragmented stereotactic radiosurgery (FSR) appears to offer very high rates of control while preserving hearing and preserving facial strength.
• Observation: For some slow-growing acoustic neuromas, observation with delayed treatment may be acceptable. This is a common treatment option for elderly patients or patients with mild symptoms where the risks of treatment may be greater and where the tumor may not grow during their lifetime.

Postoperative treatment of acoustic neuroma (vestibular schwannoma)

After treatment of acoustic neuroma, some patients experience hearing loss, cerebrospinal fluid leakage, facial nerve damage and other problems. Johns Hopkins offers comprehensive surgical treatment and rehabilitative care for all of these problems.

Surgical treatment of related problems

A bone-fixed speech processor (Baha) is a hearing aid that doctors surgically implant under the skin near the ear. The device grows into the bones of the skull and promotes the normal transmission of sound in the bones. The Baha speech therapist transmits sound vibrations within the skull and inner ear that stimulate the nerves of the inner ear, enabling the patient to hear.

We may recommend that some patients use regular hearing aids instead of a Baha speech therapist.

Patients with neurofibromatosis 2 often present with acoustic neuromas in both ears. This results in severe hearing problems or deafness in both ears. Cochlear implants can help provide these patients with a sense of sound and help them understand speech. The device consists of an external stethoscope and a device that our doctors surgically implant under the skin near the ear.

Cochlear implants bypass damaged parts of the ear and directly stimulate the auditory nerve. They generate signals from the auditory nerve to the brain, which recognizes the signals as sound.

Cerebrospinal fluid leakage is a common problem after surgical removal of an acoustic neuroma. The leaks are caused by a hole or tear in the dura, which is the membrane that covers the brain. Doctors monitor patients closely for CSF leakage, and if this occurs, they may perform an operation to plug the opening that is leaking CSF.

Repair of facial nerve damage

If a patient’s facial nerves are damaged by an acoustic neuroma, plastic surgeons may perform procedures to help restore movement in the face.

What are the complications of acoustic neuroma (vestibular schwannoma)?

If the tumor becomes large enough, it can press on the brainstem. This can affect nerve function or become life-threatening.

Acoustic neuroma and its treatment in Türkiye

The medical staff of surgical teams, doctors and consultants in REHABTÜRK can provide the best treatment options and free consultations – by striving to keep abreast of the latest medical technologies and methods.

Ask for a free consultation.