Q&A: Understanding acoustic neuroma

Acoustic neuroma is a benign tumor, which means it isn’t cancerous. It begins in the Schwann cells of the vestibular nerve, which is associated with balance. It generally affects hearing and balance.

Although acoustic neuromas are benign, these tumors can be dangerous if they grow large and press against the brainstem or brain.

We recently spoke with Paul W. Gidley, M.D., to learn more about acoustic neuroma symptoms, diagnosis and treatment options. Here’s what he had to say.

What are common symptoms of acoustic neuroma?

Hearing loss and/or ringing sound (tinnitus) in one ear are the most common acoustic neuroma symptoms. When asked directly, many patients report a vague sense of being off-balance, especially if they turn quickly. Facial numbness, headache, and facial paralysis also can occur; these are usually signs of a large tumor.

How is acoustic neuroma typically diagnosed?

Typically, diagnosis starts with an audiogram. Many patients see an otolaryngologist (ENT) for hearing loss or a ringing sound, and their audiogram shows hearing loss in one ear. The definitive test is an MRI scan with contrast. MRIs can identify tumors as small as 1 mm. Some patients have an MRI scan performed for a common complaint, such as a headache, and this MRI ends up spotting an acoustic neuroma.

Recent studies have shown an increase in the number of acoustic neuroma cases. What accounts for this increase?

MRIs have become more prevalent and accessible, so it’s likely that the more MRIs that are performed, the more acoustic neuroma tumors are diagnosed.

Bilateral acoustic neuroma is often a sign of neurofibromatosis type 2 (NF-2). What do people with bilateral acoustic neuroma need to know about this genetic disorder?

NF-2 is a rare genetic disorder associated with bilateral acoustic neuromas. There is a high risk that it can be passed on to children of affected adults. These tumors usually become symptomatic in young people (under the age of 20), whereas sporadic acoustic neuromas are usually picked up in adults 40 years or older.

NF-2 causes more than just bilateral acoustic neuromas, though. This disorder can affect the entire nervous system. Meningiomas, other cranial nerve neuromas and spinal nerve tumors also are seen. 

NF-2 patients have special needs and should be seen at a cancer center that can help address their needs.

How is acoustic neuroma typically treated at MD Anderson?

We have a specialized team of physicians that evaluate and treat acoustic neuromas. The treatment options vary depending on the patient’s age, hearing, overall health and the tumor size and location. 

The options are: observation with serial imaging, surgery or stereotactic radiosurgery. Our surgeons are among the most experienced in the nation in treating acoustic neuromas.

We have long conversations with patients about their options, as well as the risks, benefits and expected outcomes. In most cases, patients make the final decision about their acoustic neuroma treatment.

What new acoustic neuroma research is being done at MD Anderson?

We are constantly looking at our results to improve patient outcomes. Our team has been looking at the DNA of tumors that have regrown despite previous treatment. We also have had a lot of success with preserving hearing in patients with small tumors.   

What can be done to help patients manage hearing loss and problems associated with acoustic neuroma?

For patients with mild or moderate degrees of hearing loss, a conventional hearing aid can help. Patients with more severe hearing loss in one ear can use specialized hearing aids that take sound from the deaf side and route it to the hearing ear.

Other problems include facial paralysis, dizziness or balance changes. Fortunately, the rate of facial paralysis in our patients is very low. MD Anderson’s plastic surgeons help us in managing this problem. When patients experience dizziness and balance changes, our vestibular therapists help patients rehabilitate their balance.

What’s your advice for someone who’s just been diagnosed with acoustic neuroma?

Go to a cancer center that (a) sees lots of patients with acoustic neuromas, (b) uses a multidisciplinary approach, (c) can offer all treatment modalities, and (d) that is willing to take the time speak with you about your treatment options, risks and benefits and expected results.