What is a vestibular schwannoma?
A vestibular schwannoma (commonly known as an acoustic neuroma or acoustic tumor) is a benign, non-cancerous growth that develops on the hearing and balance nerve. This nerve connects the ear and the brain.
Acoustic neuromas grow very slowly, averaging about 1.5 millimeters per year. Several studies have demonstrated that more than half of all acoustic neuromas show little or no growth over a long period of time of observation (five to 10 years). No environmental or dietary factors are known to influence the growth rate of acoustic neuromas.
Acoustic neuroma causes
The majority of acoustic neuromas occur sporadically and are not inherited. A small percentage of acoustic neuromas (5%) are associated with a genetic disorder known as Neurofibromatosis Type 2 (NF2). Individuals with NF2 often develop tumors on both sides of the hearing and balance nerve at a younger age. The also typically develop benign tumors on the brain and spine.
There is no evidence to suggest cell phone use or noise exposure are linked to the development of acoustic neuromas.
Acoustic neuroma symptoms
Although acoustic neuromas arise from the balance nerve, the most common symptoms that patients experience are single-sided asymmetric hearing loss, ear fullness, or tinnitus (ringing in the ear). The degree of hearing loss is not always associated with the size of the tumor. Many patients experience few symptoms even with a large tumor.
Acoustic neuroma diagnosis
- Acoustic neuromas can be difficult to diagnose, because symptoms (including hearing loss, ringing in the ear and imbalance) usually develop slowly and are often ignored.
- Every patient with asymmetric hearing loss (or different hearing levels for each ear) should receive an MRI to look for an acoustic neuroma.
- Individuals who experience a sudden drop in hearing should also be referred for an MRI. The likelihood of having an acoustic neuroma in this scenario is about 1%.
- Individuals experiencing asymmetric hearing loss or a sudden loss of hearing should contact the Audiology Department at The Ohio State University Wexner Medical Center. Our dedicated team offers advanced hearing testing to meet your needs, helping to provide you with a proper diagnosis, effective treatment plan and fast, optimal results.
Acoustic neuroma management
Tumor size, hearing ability, age and overall health are all important in determining the best treatment for an acoustic neuroma. Our multidisciplinary team will work with you to select the best approach and provide you with the most optimal outcomes. Management approaches include:
Treatment through observation
- If the tumor is small and you are experiencing few symptoms, you may only need to have the tumor checked annually via an MRI. Smaller tumors may grow very slowly or not at all over a period of time. However, your hearing may still decline over time even if the tumor doesn’t grow.
Treatment through stereotactic radiation
- Stereotactic radiation is a non-surgical procedure used on a tumor that's demonstrating growth (determined through multiple MRIs). The radiation is administered via one or more outpatient appointments and does not require a lot of recovery time.
- Radiation will stop the growth of the tumor in most cases; however, it does not remove the tumor and could adversely affect hearing.
- After completion of radiation, you will receive an annual MRI to monitor the tumor.
Treatment through microsurgery
Some patients choose a surgical approach for their tumor management. This decision is highly individualized and dependent on a number factors, including tumor size, tumor location and residual hearing. Your overall health also plays an important role in the decision making.
At Ohio State Wexner Medical Center, our treatment team has extensive experience in the three surgical approaches available for acoustic neuromas:
- The Translabyrinthine approach is performed through an incision behind the ear. Through this technique, the surgeon will remove part of the temporal bone and inner ear to access the tumor. This approach is useful for large tumors, for patients with substantial hearing loss, and if hearing preservation is unlikely when tumors are > 3 cm in size.
- The Retrosigmoid approach is performed through an incision behind the ear, but does not involve removal of the temporal bone or inner ear. This approach is useful if you have a small to medium-sized tumor that does not extend all the way to the end of the internal auditory canal.
- The middle cranial fossa approach is performed through an incision in front of and above the ear. The inner ear is preserved and the tumor is accessed from above. This surgical approach is ideal for small tumors, tumors located in the internal auditory canal, and in patients with good pre-operative hearing. The middle fossa approach offers the highest likelihood of hearing preservation in the long-term.
Resources for patients
At Ohio State, our team is committed to creating an individualized, optimized treatment plan for every patient. We are happy to provide an initial consultation with you and your family members to discuss your problem, goals and concerns. We will also review your hearing tests, diagnostic tests (such as MRIs), and any other relevant medical information. Call 614-366-3687 to schedule an appointment.
Many patients with acoustic neuromas seek out advice and support from support groups. The Acoustic Neuroma Association (ANA) is a great resource for patients and has many groups that focus on relevant acoustic neuroma issues, including headaches pre- and post-treatment, young adults, caregivers and facial paralysis. For more information on support groups in your area, please visit: https://www.anausa.org/programs/support-groups/find-a-group/support-groups-by-state.
Why choose Ohio State for acoustic neuroma care?
Experience: The Ohio State University Wexner Medical Center has been successfully treating patients with acoustic neuromas for decades. Many of our patients are referred to us by local providers due to our outstanding reputation.
Super specialists: Our multidisciplinary team of neurologists, neurosurgeons and audiologists work together to provide highly specialized and exceptional care to patients. Our team also includes experts from radiation oncology, radiology, and neuro-oncology, who have extensive expertise in radiosurgery and medical management.
Hearing preservation: Ohio State offers three surgical approaches for microsurgical resection, as well as radiosurgery and observation treatment plans. We perform middle fossa approaches and have a high success rate of hearing preservation for patients.
Reduced complications: Our patients have low complication rates, reduced operative time, and shorter length of hospital stay.
Comprehensive rehabilitation: We offer sophisticated balance testing and have highly experienced vestibular physical therapists who work alongside our physicians as a part of an integrated balance rehabilitation program.