Acoustic neuroma (neurinoma)

The Acoustic neuroma is a benign tumor that affects the equilibrium nerve. Although benign, it can cause significant discomfort in the affected patient. In the event of symptoms such as dizziness, hearing problems or balance disorders, an ear, nose and throat specialist should be consulted immediately so that a diagnosis of the cause can be made as early as possible and, if necessary, the acoustic neuroma can be treated as soon as possible.

What is an acoustic neuroma?

Acoustic neuroma is a benign tumor that affects the equilibrium nerve. The balance nerve connects the balance organ with the brain.

The acoustic neuroma is a benign, slowly growing tumor inside the skull. The benign neuroma is formed from the outer shell of the nerve cells - the so-called Schwann cells - of the equilibrium nerve.

Since the equilibrium nerve has almost the same route into the brain as the auditory nerve, symptoms that affect the hearing can also occur as the acoustic neuroma grows. Typically, the neuroma does not metastasize. Those affected often notice the acoustic neuroma through the occurrence of tinnitus, sudden hearing loss or unilateral hearing loss.

But the facial nerve can also be affected by an acoustic neuroma, which can also lead to paralysis in the facial area. If the neuroma continues to grow, there is a risk that it will crush the brain stem or the cerebellum, which can have serious consequences. Appropriate treatment should be initiated as soon as possible, especially in children and adolescents, in order to contain the consequences of acoustic neuroma.

causes

The cause of acoustic neuroma is unknown to scientists and doctors. However, the risk of developing a neuroma increases with age. If the acoustic neuroma develops in connection with neurofibromatosis type II, the disease is based on a genetic change in the genetic make-up.

These are responsible for the development of benign tumors of the brain and spinal cord. Signs of neurofibromatosis can include a bilateral acoustic neuroma and the occurrence of the disease at a young age.

In addition, a neuroma can develop in connection with radiation exposure to cancer on the head. Even many years after completing cancer, there is a possibility that formerly irradiated cancer patients will develop acoustic neuromas.

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Symptoms, ailments & signs

An acoustic neuroma (neurinoma) is a benign tumor, but it can cause considerable symptoms. In the neuroma, the symptoms are always the result of processes of repression. The tumor itself grows very slowly, but does not form metastases. In this way, the person affected can remain symptom-free for decades, whereby the tumor is then often an incidental finding.

But when it has reached a certain size or sits in an inconvenient place, symptoms arise that depend on which nerves are being displaced. Often the first symptom is a slowly increasing unilateral hearing loss. In rarer cases, it starts suddenly, as in a sudden hearing loss. This leads to repeated hearing loss.

In addition to hearing disorders, there are also frequent problems with balance. Usually the hearing disorders are one-sided. However, bilateral hearing loss is rarely observed. The hearing loss can lead to deafness. The imbalances vary in intensity. Spinning vertigo is rare. More often, those affected feel that the ground is swaying beneath them.

In addition to these common symptoms, there are also less common symptoms. If the seventh cranial nerve is displaced, facial paralysis can occur. Taste disorders and the stagnation of tear production are also possible. Furthermore, the displacement processes can also lead to numbness and pain in the face. In very severe cases, movement disorders, circulatory problems or shortness of breath can occur with possible death.

Diagnosis & course

If a patient is suspected of having an acoustic neuroma, the doctor will refer him to an ear, nose and throat doctor. After a detailed questioning of the patient, the ears are examined and an audiogram is performed.

The ENT doctor uses this to check whether the patient can no longer hear certain frequencies on one or both sides. Another diagnostic option is brainstem audiometry (BERA), which checks the auditory nerves. The examination also provides information about the functionality of the brain regions that are involved in hearing. With an acoustic neuroma, both tests usually show results that deviate from the norm.

Tests of the sense of balance can also provide information about the presence of a neuroma. In order to confirm the suspected diagnosis, the ENT doctor will order an MRI, i.e. an imaging method, of the head, on which he can reliably detect the acoustic neuroma.

When should you go to the doctor?

If you suspect you have an acoustic neuroma, a doctor must be consulted immediately. Even if this is a benign tumor, it can lead to considerable restrictions and discomfort in the patient's life. In this case, medical treatment is essential. The complaint will usually not go away on its own or heal spontaneously.

Those affected suddenly suffer from hearing problems or from deafness. Should these complaints arise for no particular reason, a doctor should be consulted immediately. Treatment is also necessary if tinnitus or vision problems occur. Furthermore, patients often suffer from loss of balance and facial paralysis. These symptoms can also be a sign of acoustic neuroma. As a rule, the ENT doctor can be consulted directly, who can diagnose and treat the acoustic neuroma. Early detection and treatment will not reduce the patient's life expectancy.

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Treatment & Therapy

There are different therapy options for an acoustic neuroma, depending on its location and size. In the case of very small neuromas that do not cause the patient any symptoms and grow slowly, one can wait and see in individual cases. Of course, the findings of the acoustic neuroma require constant control and observation in order to notice the progression of the disease as early as possible.

The second way to treat an acoustic neuroma is through surgery. This method is mainly used if the acoustic neuroma has already grown very large and causes considerable discomfort, or if the patient becomes ill at a young age. If the acoustic neuroma is not yet larger than two centimeters, the treating doctor often recommends irradiating the benign tumor.

All three treatment methods have advantages and disadvantages, which is why the decision about the treatment of acoustic neuroma should be carefully considered. It is advisable for patients to seek advice from several ear, nose and throat specialists in order to find out the most suitable therapy method for their acoustic neuroma.

Outlook & forecast

The acoustic neuroma causes various complaints that usually occur in the patient's head area. Those affected mainly suffer from dizziness and hearing problems. It is not uncommon for equilibrium disorders to occur, which can negatively affect the everyday life of the person concerned. The severe dizziness often leads to a loss of consciousness, which can lead to various injuries from falling.

In the worst case, the patient suffers complete hearing loss due to the acoustic neuroma. For many people, hearing loss is a major complication that sometimes leads to depression. Furthermore, tinnitus or other noises in the ears can occur that reduce the quality of life. Sometimes the face becomes paralyzed and the affected person may continue to suffer from visual disturbances. There is usually no blindness. In many cases, the hearing damage only relates to certain frequency ranges.

In most cases, acoustic neuroma is treated surgically and usually leads to a positive course of the disease. The tumor can also be irradiated. The life expectancy of the patient is not influenced by the acoustic neuroma.

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prevention

Since the acoustic neuroma is a tumor disease, there is unfortunately no known effective prevention. One can only try to keep the body as fit and healthy as possible through a healthy lifestyle and sufficient exercise. Since there is a familial accumulation of acoustic neuromas, the children of affected patients should be examined as early as possible in order to discover the development of an acoustic neuroma as quickly as possible.

Aftercare

The acoustic neuroma requires weeks of follow-up care. Therefore, the tumor should not necessarily be operated on far away from where you live. The regular journeys there and back must remain manageable for the person concerned.

Surgical removal of the acoustic neuromon is still the most effective therapy option today. Apart from the surgical risks associated with interventions in and on the head, the postoperative healing prospects are quite good. The more modern the surgical procedures used and the better the aftercare, the sooner the patient can be discharged as cured. Experienced surgeons can largely regain its full quality of life.

Preliminary examinations and follow-up care should, if possible, remain in one hand. It has become established as knowledge that the surgeon himself has acquired the best knowledge of the patient's acoustic neuroma through the preliminary discussions, the preliminary examinations and the subsequent operation. In addition, he can adapt his operative strategy to the actual findings at any time during the operation.

The aim is to achieve the best possible surgical result. Complete tumor removal is particularly successful in the case of small acoustic neuromas. Larger neuromas must be removed piece by piece. They involve greater surgical risks. The follow-up examinations should keep an eye on the problems that often arise postoperatively. These include dizziness and balance problems, numbness or surgical facial paralysis. The latter requires physiotherapeutic treatment in aftercare. A neurologist in your home town can take care of later check-ups.

You can do that yourself

An acoustic neuroma can develop over years or even decades. When the condition is diagnosed, permanent damage such as balance disorders or hearing disorders have often already developed. The medical treatment, which mostly focuses on surgical interventions and regular follow-up checks, can be supported by rest.

Mentally strenuous tasks are often too stressful and should be reduced if possible if they are associated with an accident risk. A career change may be necessary if the condition makes it impossible to reliably carry out the respective activity. Patients should consult the responsible doctor and, if necessary, also consult a therapist.

If the acoustic neuroma is detected early, no further measures are often necessary. A simple surgical procedure, after which the patient has to take it easy, is sufficient for a full recovery. However, those affected should look out for unusual symptoms and have regular routine examinations carried out. If there are physical complaints after an operation or if the hearing problems do not decrease, various aids such as a hearing aid may have to be organized.