Acoustic neuroma : Causes-Symptoms-Diagnosis-Treatment

 What Is Acoustic Neuroma?

An acoustic neuroma, additionally called a vestibular schwannoma, is a non-cancerous tumor that occurs around your balance and hearing nerves that join your internal ear along with your mind.

The term schwannoma way the tumor advanced from Schwann cells. These cells surround nerves in the peripheral worried gadget (nerves outside the brain and spinal cord) and generally insulate and support the function of nerves. Schwannomas can occur in nerves throughout the frame, however in the head, these maximum usually occur from the vestibular nerve, or balance nerve.

An acoustic neuroma is a form of non-cancerous (benign) brain tumor. It's additionally called a vestibular schwannoma.

A benign mind tumor is an increase inside the brain that usually grows slowly over many years and does not now spread to other components of the frame.

Acoustic neuromas develop on the nerve used for listening to and stability, that could reason problems including hearing loss and unsteadiness.

Acoustic neuromas generally tend to have an effect on adults aged 30 to 60 and normally haven't any apparent cause, despite the fact that a small wide variety of cases are the result of a genetic condition known as neurofibromatosis kind 2 (NF2).

Medical terms

Types of  Acoustic neuroma

There are two types of acoustic neuromas:

• Sporadic, unilateral acoustic neuromas. These tumors only grow on one facet of the frame in 95% of patients. They occur from sporadic (sudden), nonhereditary mutations. These unilateral acoustic neuromas may additionally broaden at any age, but maximum generally occur in humans among the ages of 30 and 60.

• Genetic, bilateral acoustic neuromas. Acoustic neuromas on each facet of the frame only arise in people who've the genetic disorder neurofibromatosis kind 2, a mutation in chromosome 22 that influences the gene accountable for manufacturing of Schwann cells. These sufferers often produce other schwannoma-like tumors during the body, and treatments for those tumors are regularly special from the treatment for unilateral tumors.

Symptoms Acoustic neuroma

• Some individuals, mainly people with small tumors, may not have any associated signs and symptoms (asymptomatic). However, even small tumors, relying upon their place, can reason giant signs and symptoms or bodily findings.
• Acoustic neuromas are sluggish-growing tumors that could eventually cause an expansion of signs and symptoms by pressing against the eighth cranial nerve. Hearing loss in one ear (the ear affected by the tumor) is the initial symptom in about ninety percent of patients. Hearing loss is usually slow, even though in a few uncommon cases it is able to be surprising. In a few instances, hearing loss can also differ (get worse and then improve). Hearing loss may be observed by using ringing inside the ears, a condition referred to as tinnitus, or with the aid of a feeling of fullness within the affected ear. In a few instances, affected individuals may additionally have issue know-how speech that is disproportional to the quantity of hearing loss.
• Acoustic neuromas can also cause dizziness and troubles with stability which includes unsteadiness. In rare instances, dizziness or balance issues may additionally occur before substantial listening to loss. Because these tumors normally develop very slowly, the body can often make amends for these stability problems.
• Although slow-developing, acoustic neuromas can finally turn out to be large enough to press towards neighboring cranial nerves. While uncommon, signs as a result of the involvement of different cranial nerves include facial weak spot or paralysis, facial numbness or tingling, and swallowing difficulties. Facial numbness or tingling may be constant or it may come and move (intermittent).
• In some sufferers, acoustic neuromas may grow big enough to press in opposition to the brainstem, stopping the everyday go with the flow of cerebrospinal fluid among the mind and spinal twine. This fluid can accumulate in the skull, leading to a phenomenon referred to as hydrocephalus, which causes stress at the tissues of the brain and results in a spread of signs and symptoms which includes headaches, an impaired ability to coordinate voluntary actions (ataxia), and intellectual confusion. Headaches may additionally occur in the absence of hydrocephalus and in a few uncommon instances may be the primary signal of an acoustic neuroma. In very uncommon cases, an untreated acoustic neuroma that presses on the brain can cause life-threatening headaches.
• Acoustic neuroma often goes undetected for many years, and its symptoms can include problems with hearing and balance. The tumor may pressure nearby nerves that control facial muscles and sensation (facial and trigeminal nerves). If you are near a blood vessel or brain structure, it may cause problems.

If the tumor grows, it may cause more obvious or severe signs and symptoms.

Some signs and symptoms of acoustic neuroma may include:

• Hearing loss often gradually worsens over months to years, although in rare cases it can suddenly worsen. It may occur on only one side, or be more severe on one side.

• Ringing (tinnitus) in the affected ear

• Unsteadiness or loss of balance

• Dizziness (vertigo)

• If someone experiences facial numbness or weakness, or if they lose muscle movement, it means they are very sick.

There are rare cases where an acoustic neuroma can grow large enough to compress the brainstem and become life-threatening.

When to see your doctor

If you are experiencing hearing loss in one ear and ringing or trouble with your balance, see your doctor.

If acoustic neuroma is diagnosed early, the tumor may not grow large enough to cause serious consequences such as total hearing loss.

Causes Acoustic neuroma

Acoustic neuromas can be linked to a problem with a gene on chromosome 22. Normally this gene produces a tumor suppressor protein that helps control the growth of Schwann cells that cover the nerves.

It is not known what causes this problem with the gene. In most cases of acoustic neuroma, there is no known cause. This faulty gene is also inherited in neurofibromatosis type 2, a rare disorder that usually involves the growth of tumors on the hearing and balance nerves on both sides of your brain. A bilateral vestibular schwannoma is a tumor on either side of the brain.

Researchers do not understand why acoustic neuromas form. Most of the time, the tumors stand up spontaneously — without an acknowledged cause or purpose. For a small institution of humans, the acoustic neuroma develops as a part of NF2.

Risk factors Acoustic neuroma

Neurofibromatosis type 2

Acoustic neuroma is not caused by any one specific factor, but rather it is more likely to occur in people who have a parent with the rare genetic disorder neurofibromatosis type 2. However, neurofibromatosis type 2 only accounts for about 5% of acoustic neuroma cases.

Neurofibromatosis type 2 is characterized by the development of noncancerous tumors on the hearing and balance nerves on both sides of the head as well as other nerves.

Neurofibromatosis type 2 is a disorder that is caused by a mutation on one of the two autosomes. This means that it can be passed down from just one parent (the dominant gene). Each child of an affected parent has a 50-50 chance of inheriting the condition.

Complications Acoustic neuroma

If untreated, an acoustic neuroma can grow big enough to cause pressure on the brain stem. The tumor can block the drift of cerebrospinal fluid (CSF) among the mind and the spinal twine, inflicting a buildup of the fluid inside the mind.

Because the skull is a closed structure, excess fluid in the brain (hydrocephalus) can press in opposition to the brain, causing unsteady motion and absence of coordination (ataxia), complications and confusion.

A neuroma (a tumor of the nerve) may cause a variety of permanent complications, including:

• Hearing loss

• Facial numbness and weakness

• Difficulties with balance

• Ringing in the ear

If you have a large tumor pressing on your brainstem, this may prevent the normal flow of fluid between your brain and spinal cord (cerebrospinal fluid). This can cause fluid to build up in your head (hydrocephalus), which can increase the pressure inside your skull.

Prevention Acoustic neuroma

You can not save your acoustic neuromas from growing. But you may reduce your hazard of headaches by means of listening to the way you experience and feature. If you hear any signs and symptoms such as listening to loss, dizziness or ringing in your ears, don’t disregard your concerns.

Talk to your healthcare issuer who can carry out a full diagnosis and get to the lowest of your signs. The earlier an acoustic neuroma is detected, the better the probabilities for complete tumor elimination and listening to protection.

Diagnosis Acoustic neuroma

Your doctor will ask about your symptoms and perform some tests. These tests may include an ear exam.

• Hearing test (audiometry).In this test, a hearing specialist will present sounds to one ear at a time. The specialist will also present sounds of various tones at faint levels in order to find out when you can barely hear them.
  The audiologist may present various words to determine your hearing ability.

• Imaging. Acoustic neuroma can usually be diagnosed by using a magnetic resonance imaging scan with contrast. This test can detect tumors that are as small as one to two millimeters in diameter. If MRIs are not available or you cannot have an MRI scan, a computerized tomography scan may be used. However, this test is more expensive and may not be necessary in some cases. CT scans may not be able to detect very small tumors.

Treatment Acoustic neuroma

There are numerous special treatment alternatives for an acoustic neuroma, relying on the scale and position of your tumor, how rapid it's developing and your fashionable health.

 Clinic offers surgery for acoustic neuroma.

Your treatment for an acoustic neuroma will vary depending on your symptoms and medical history.

• The size and growth of the acoustic neuroma will be determined by the amount of pressure applied to the tumor.

• Your overall health

• Severity of symptoms

Your doctor may suggest one or more of three potential treatments for acoustic neuroma: monitoring surgery or radiation therapy, or a combination of the two.

Monitoring

If you have a small acoustic neuroma that is not growing or is growing slowly, and does not cause any symptoms or signs, your doctor may decide to monitor it. Monitoring may be recommended for people who are older or otherwise not good candidates for more aggressive treatment.

Your doctor may recommend that you have regular imaging and hearing tests to see if the tumor is growing and how quickly. If the scans show that the tumor is growing or if symptoms from the tumor are progressing, you may need to undergo additional testing. Treatment

Surgery

If you have an acoustic neuroma, you may need surgery to remove it. Acoustic neuromas are especially dangerous if they are large or located near other vital organs.

• Continuing to grow

• Very large

• Causing symptoms

Your surgeon may use one of several techniques to remove an acoustic neuroma, depending on the size and status of your tumor.

The goal of surgery is to remove the tumor and prevent facial paralysis. Sometimes it is not possible to completely remove the tumor, depending on the location and size of the tumor.

Acoustic neuromas are treated with surgery, which is done under general anesthesia. The tumor is removed through the inner ear or through a window in your skull.

If surgery is needed to remove a tumor, it may worsen symptoms if the hearing or facial nerve is damaged. Hearing may be lost on the side where the surgery was performed, and balance usually suffers for a short time.

Complications may include:

• Wound or nose bleeding

• Hearing loss

• Facial weakness or numbness

• Ringing in the ear

• Balance problems

• Persistent headache

• Meningitis is a rare infection of the cerebrospinal fluid.

• Very rarely, stroke or brain bleeding

Radiation therapy

Radiation therapy is used to treat acoustic neuroma in several ways.

• Stereotactic radiosurgery.If your doctor thinks that radiation therapy will be effective for treating your cancer, he may recommend stereotactic radiosurgery. This type of radiation therapy is often used if the tumor is small (less than 2.5 cm in diameter), you are over the age of 50, or you cannot tolerate surgery.
  Radiosurgery such as Gamma Knife therapy uses many tiny gamma rays to deliver a precisely targeted dose of radiation to a tumor.Stereotactic radiosurgery is used to stop the growth of a tumor, preserving facial nerve function and possibly preserving hearing.You may not see any effects from radiosurgery for weeks, months, or even years. Your doctor will monitor your progress with follow-up imaging studies and hearing tests.Risks of radiosurgery include:

• Hearing loss

• Ringing in the ear

• Facial weakness or numbness

• Balance problems

• Continued tumor growth

• Stereotactic radiotherapy.Stereotactic radiotherapy (SRT) delivers a small dose of radiation to the tumor over several sessions. This technique is used to curb the tumor's growth without damaging surrounding brain tissue.

• Proton beam therapy.This type of radiation therapy uses high-energy beams of positively charged particles called protons. These particles are delivered to the affected area in targeted doses to treat tumors and minimize radiation exposure to the surrounding area.

Supportive therapy

If your doctor removes or stops the growth of a tumor, they may also recommend supportive therapies to help you with symptoms or complications, such as dizziness or balance problems.

Hearing loss can be treated with cochlear implants or other treatments.

If you are having trouble with your acoustic neuroma, visit Mayo Clinic for help. They will provide you with supportive care.

Coping and support

When facing the possibility of hearing loss or facial paralysis, it can be quite stressful. Here are some things to keep in mind if you're feeling stressed:

• Educate yourself about acoustic neuroma. The more information you have, the better prepared you will be to make good decisions about treatment. Besides talking to your doctor and your audiologist, you may want to talk to a counselor or social worker. Or you may find it helpful to talk to other people who have had an acoustic neuroma and learn more about the condition. Some of the patients interviewed shared their experiences during and after treatment.

• Maintain a strong support system.Your family and friends can be there to help you through this difficult time, but sometimes you may find the support and understanding of others with acoustic neuroma comforting.
  Your doctor or social worker may be able to connect you with a support group. You may also find a support group through the Acoustic Neuroma Association.

Preparing for your appointment

You may see your family doctor or a general practitioner first. Your doctor may then refer you to a doctor who is trained in ear, nose, and throat conditions or a doctor who is trained in brain and nervous system surgery (neurosurgeon).

Be ready for your appointment by knowing what to expect. This information will help you feel more prepared and comfortable during your appointment.

• Hearing Rehabilitation
• A middle ear transplant

What you can do

• When you experience symptoms, write them down. This will help you remember what is happening and to track your progress.You should bring any materials that may seem related to the reason for which you scheduled the appointment, even if they are not specifically mentioned on the appointment sheet.

• Make a list of all medications,What vitamins or supplements are you taking?

• Invite a family member or friend to join you in your project.If possible, bring someone with you during your appointment. Sometimes it is hard to remember all the information that is provided during an appointment, so another person can help you remember.

• Write down questions to ask your doctor.

Preparing a list of questions will help you have the most productive visit with your doctor. Some basic questions to ask your doctor about acoustic neuroma may include:

• What is likely causing my symptoms?

• What else could be causing my symptoms?

• What kinds of tests do I need?

• What treatment options are available?

• Which one do you recommend for me?

• What are the chances of side effects from each treatment option?

• What happens if I do nothing?

• Can I take any printed materials home with me? What websites do you think I should visit?

Do not hesitate to ask questions during your appointment. You can also prepare questions to ask your doctor.

What you can expect from your doctor

Your doctor may ask you a number of questions. Being prepared to answer them may allow time to go over any points you want to spend more time on. Your doctor may ask:

• When did you start to experience symptoms?

• Have your symptoms been continuous or occasional?

• How severe are your symptoms?

• Do you have any family members with an acoustic neuroma?

• At its current level, do you feel the hearing in the affected ear is useful to you in any way? For example, can you use that ear on the telephone, or does that ear help you tell where sound is coming from?

• Do you have regular headaches currently or have you had them in the past?

General summary