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An acoustic neuroma is a benign tumor that can significantly impact hearing and balance
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The most common symptom of an acoustic neuroma is asymmetric hearing loss, which is characterized by hearing loss that’s noticeably worse in one ear. It is often accompanied by dizziness and tinnitus, or ringing in the ears.
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The Director of the Swedish Acoustic Neuroma Program explains the condition, outlines diagnosis and treatment options and shares how to determine if surgery is the best option.
Acoustic neuromas are uncommon, but they can have a significant impact on hearing and balance when they occur. Experts agree early detection and expert care are among the best ways to achieve the best outcomes, but the condition’s often subtle symptoms can make it difficult to detect in its early stages.
We spoke with Sachin Gupta, M.D., to learn more about this rare condition, diagnosis, treatment options and determining if surgery is the best route. Dr. Gupta is a board-certified neurotologist who specializes in the treatment of disorders of the ear and skull base. He is the Director of the Swedish Cochlear Implant Program and Director of the Swedish Acoustic Neuroma Program. Here’s what he shared.
Understanding acoustic neuroma
“An acoustic neuroma is a benign tumor of one of the balance nerves, called the vestibular nerve. Benign means it doesn’t spread to other parts of the body. However, it can still cause problems by pressing on nearby structures,” says Dr. Gupta.
The vestibular nerve is part of the eighth cranial nerve, which is often called the balance and hearing nerve. The nerve is surrounded by an outer layer of cells, called Schwann cells, that provide insulation and protection. If too many Schwann cells are produced, they become an acoustic neuroma.
Symptoms can vary, depending on the size and location of the tumor. Since acoustic neuromas are traditionally slow-growing, symptoms typically start after age 30.
“The most common symptom is hearing loss on one side, which we call asymmetric hearing loss. About half of the patients also have ringing in their ears, or tinnitus. A smaller percentage experience dizziness,” says Dr. Gupta.
If the tumor becomes large enough, it can interfere with the nerves controlling the muscles in the face, causing facial weakness and loss of feeling.
Diagnosis
Because symptoms like hearing loss or dizziness can have many causes, diagnosis usually begins with a visit to your doctor and a referral to an ear specialist.
“People typically seek medical care from their primary care doctor after they experience symptoms. The next step is usually a referral to a neurotologist, a doctor specializing in recurrent or difficult-to-treat inner ear problems,” says Dr. Gupta.
Diagnosis may include:
- A hearing test
- Balance and equilibrium assessment
- MRI of the brain
Treatment
Acoustic neuromas vary in size, ranging from small tumors less than 1.5 cm to large tumors measuring 3.0 cm or more. Treatment depends on the tumor’s size, growth rate and the symptoms it causes.
Observation
For many acoustic neuromas, the best treatment is often a “watchful waiting” approach, says Dr. Gupta.
“For small tumors less than 1.5 cm that are not pressing on the brain, observation is reasonable,” says Dr. Gupta. “Many of these tumors don’t grow, so some can be monitored indefinitely. Some patients never need further treatment.”
Observation includes yearly MRIs and hearing tests. Treatment is adjusted according to the results, according to Dr. Gupta. “If a patient’s hearing worsens, a hearing aid can help. For balance issues, vestibular rehabilitation therapy with a physical therapist can be very beneficial,” he adds.
Radiation
For patients who’ve already had surgery and have residual tumor growth, radiation treatment can be an option. Radiation can also be considered for patients with growing tumors, who desire to preserve hearing. Patients over 65 may also be good candidates for this type of treatment.
A technique called stereotactic radiosurgery focuses beams of radiation into the center of the tumor to stop its growth. It is often the most effective choice for someone who is not a good candidate for surgery due to their health issues or age. Risks include hearing loss and dizziness.
“Radiation is usually for patients over 65 or for those who’ve already had surgery and have residual tumor growth. Recovery is straightforward, and follow-up MRIs monitor for regrowth,” says Dr. Gupta.
Surgery
Larger tumors or tumors that are growing more quickly may require surgery. Although surgery will not improve hearing ability, there are several reasons surgery could still be the best care choice, according to Dr. Gupta.
“If someone already has significant hearing loss, they may opt to remove the tumor since there’s no functional hearing to lose. Others who experience disabling dizziness often do better after surgery because we cut the balance nerve and the brain readjusts to restore balance,” he explains. “We also see patients who choose surgery proactively if the tumor is close to the brain or if they prefer to address it while they’re younger or have better insurance coverage.”
Surgery takes about six to eight hours to complete, and patients usually stay in the hospital three to four days.
“The goals are to remove the tumor without injuring the facial nerve, which controls facial movement. In some cases, we can preserve hearing, but in many cases, patients lose hearing afterward,” says Dr. Gupta.
Comprehensive, coordinated care
Because every acoustic neuroma is unique, treatment requires a highly coordinated, multispecialty approach. At Swedish, patients benefit from advanced technology, surgical expertise and a collaborative team that provides seamless care from diagnosis through recovery.
“We have a comprehensive, in-house team that includes a neuro ICU, physical therapists trained in vestibular disorders, audiologists who specialize in cochlear implants and hearing aids, and specialists for facial nerve disorders,” says Dr. Gupta. “We also have a tumor board that reviews complex cases, especially when deciding between surgery and radiation. It’s a very cohesive program, and having everything on one campus really simplifies patient navigation.”
Learn more and find a physician or advanced practice clinician (APC)
Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Providence Swedish Primary Care to schedule an appointment with a primary care physician. You can also connect virtually with your doctor to review your symptoms, provide instruction and follow up as needed.
And with Providence Swedish ExpressCare Virtual, you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections and more. You can use our provider directory to find a specialist or primary care physician near you.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
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