Limbic 365Acoustic Neuroma, also known as vestibular schwannoma, is a benign tumor that grows on the vestibulocochlear nerve, which is responsible for hearing and balance. Although it is a noncancerous tumor, it can cause significant neurological symptoms and, in rare cases, can become life-threatening.
Case:
A 45-year-old male patient presented to the hospital with complaints of hearing loss in the left ear, tinnitus, and dizziness for the past few months. The patient also reported difficulty maintaining balance while walking. On examination, the patient had a positive Romberg sign and left-sided hearing loss. An MRI of the brain showed a large acoustic neuroma in the left internal auditory canal.
Pathophysiology:
Acoustic neuroma arises from the Schwann cells of the vestibulocochlear nerve. It is usually a solitary tumor, and it grows slowly over time. The exact cause of acoustic neuroma is unknown, but it is thought to be related to genetic factors, radiation exposure, and chronic inflammation.
Signs and Symptoms:
The most common symptoms of acoustic neuroma are hearing loss, tinnitus, and dizziness or vertigo. Other symptoms include:
Loss of balance or difficulty walking
Numbness or tingling in the face
Headaches
Facial weakness or paralysis
Difficulty swallowing
Changes in taste
Investigations:
The diagnosis of acoustic neuroma is made based on a combination of patient history, physical examination, and imaging studies. The following investigations are commonly used:
MRI scan of the brain and internal auditory canals
Audiometry
Balance tests
CT scan of the head
Treatment:
The management of acoustic neuroma depends on the size and location of the tumor, the age and overall health of the patient, and the severity of symptoms. The following treatment options are available:
Observation: Small tumors that are not causing symptoms can be monitored with regular imaging studies.
Surgery: The most common treatment for acoustic neuroma is surgical removal of the tumor. The goal of surgery is to remove the entire tumor while preserving hearing and other neurological functions.
Radiation therapy: Radiation therapy is an option for patients who are not good candidates for surgery or who have residual tumor after surgery.
Advises (Dos and Don’ts):
Patients with acoustic neuroma should follow these dos and don’ts:
Dos:
Follow the treatment plan recommended by the doctor.
Attend regular follow-up appointments.
Practice good balance and fall prevention techniques.
Wear a hearing aid if needed.
Seek immediate medical attention if symptoms worsen or new symptoms develop.
Don’ts:
Avoid activities that increase the risk of falls, such as standing on ladders or walking on uneven surfaces.
Do not ignore symptoms or delay seeking medical attention.
Do not self-medicate or use alternative therapies without consulting with a healthcare provider.
Reference:
Carlson ML, Habermann EB, Wagie AE, Driscoll CL, Van Gompel JJ, Jacob JT, Link MJ. The changing landscape of acoustic neuroma management in the United States-a shift toward conservatism. Otolaryngol Head Neck Surg. 2015 Jan;152(1):43-50. doi: 10.1177/0194599814551185. Epub 2014 Sep 29. PMID: 25268056.
Plotkin SR, Halpin C, McKenna MJ, Loeffler JS, Batchelor TT, Barker FG 2nd. Erlotinib for progressive vestibular schwannoma in neurofibromatosis 2 patients. Otol Neurotol. 201
