An acoustic neuroma is a kind of benign (noncancerous) brain tumor that grows on the vestibular nerve as it goes in the inner ear to the brainstem. It's among the very frequent forms of brain tumors that are benign. The primary hint of one is normally hearing loss.

The primary symptoms of an acoustic neuroma are hearing loss and tinnitus (ringing in the ears). They may be brought on by the tumor pressing on the auditory nerve. Imbalance is generally absent or mild even though the tumor really grows on the balance nerve. Since we've two equilibrium systems, the slow progressive decline resulting from the tumor can be compensated for by the opposite side.

The cochleo-vestibular nerve (also called the eighth cranial nerve) is composed of three nerves that join the inner ear to the brain. One branch -- the cochlear nerve -- carries hearing advice. Both of the other branches -- the poor and superior vestibular nerves -- carry equilibrium info to the brain. The nerves are wrapped in a layer of specialized cells. An acoustic neuroma -- also called a vestibular schwannoma -- is a tumor of the cells. If an acoustic neuroma isn't diagnosed or treated it may grow big enough significant structures in the brainstem and cause leading life threatening difficulties.

These tumors are associated with a mutation in a protein that modulates tumor suppression. Generally the tumor grows just on a single side of the head and is diagnosed between the ages of 50 and 30. Acoustic neuromas in kids are extremely infrequent. People who have a hereditary disease called neurofibromatosis type 2 develop bilateral acoustic neuromas due to the fact that they lack the tumor suppressor protein merlin. About 10% of all acoustic neuromas occur in people with neurofibromatosis.

Symptoms of Acoustic Neuroma

Acoustic neuromas typically grow slowly so the symptoms develop gradually and are not difficult to miss or misinterpret. The first & most typical symptoms of an acoustic neuroma are:

- Loss of hearing in a single ear -- This generally is not sudden, but might happen unexpectedly in 10% of instances.

- Tinnitus, a noisy, buzzing or ringing sound in the ear when there isn't any outside sound present.

Common symptoms of acoustic neuroma include:

- Numbness in the face

- Dizziness or loss of equilibrium

- Head Ache

- Mental confusion

- Facial weakness

Causes of an acoustic neuroma

Generally, the reason for an acoustic neuroma is not known.

Acoustic neuromas grow in the Schwann cells lining the vestibulocochlear nerve, and that's the reason why they're occasionally called vestibular schwannomas. Schwann cells form a sheath around nerves, helping electric signals to go through the body.

The only known risk factor for developing an acoustic neuroma is having a rare hereditary condition called neurofibromatosis type 2 (see below).

It is also not understood what causes some acoustic neuromas continue growing although some stay exactly the same size or to begin growing.

Neurofibromatosis type 2

Neurofibromatosis type 2 causes benign (non-cancerous) tumors to grow on the nerve tissue within the body, particularly inside the head cavity and back. Illness is usually characterized by an acoustic neuroma on each side that is growing from both left and right acoustic nerves.

A few of acoustic neuroma cases (about 5%) are brought on by a rare, inherited condition called neurofibromatosis type 2.

In neurofibromatosis type 2 both acoustic nerves are often changed. This implies that you are much more likely to have hearing loss. Thus, it is crucial that you address problems like sign language and lip reading on in the event you lose hearing in both ears.

Neurofibromatosis type 2 should not be mistaken with neurofibromatosis type 1, which is substantially more common and can additionally cause spinal tumors that were benign. The skin is affected by neurofibromatosis type 1 and does not cause acoustic neuromas.

How to Diagnose Acoustic Neuroma

They may be missed easily inside their first stages as the outward symptoms of acoustic neuroma are frequently subtle and slow to develop. Slow hearing loss, particularly when it happens just in a single ear, consistently must be assessed with a doctor.

In case your doctor suspects that you simply have an acoustic neuroma, they will examine you to try to find other states that can make similar symptoms. This evaluation generally will contain:

- Using tuning forks to test your hearing

- Looking using a lighted magnifying lens

- Examining your nose, throat and neck

- Checking your equilibrium

- Analyzing the nerves in your face

Your doctor also may recommend an official hearing test (audiogram) to ascertain the kind and quantity of the hearing loss.

Occasionally your doctor may recommend an auditory brainstem response test, also called evoked potentials or evoked reactions. In this test, electrodes are positioned on the entire scalp to assess the electric reactions of the brain to various sounds. The test measures the rate the sound is carried via the brain. This test will likely be strange and demonstrate a delay in the transmission if your tumor is pressing on the nerve that carries signals in the ear to the brain (the cochlear nerve).

When an evaluation and hearing testing show a potential acoustic neuroma, your doctor may order additional tests to validate the diagnosis. Most often, he/she will advocate a magnetic resonance imaging (MRI) scan. MRI uses magnetic waves to make images of structures within the body. These graphics can reveal whether you've got an acoustic neuroma, large the tumor is, and where it's found. An MRI can detect tumors as small as 2mm.

Treating an acoustic neuroma

There are many different treatment alternatives for an acoustic neuroma depending in your age, overall health, along with the size as well as standing of your tumor.

You can find there are only three approaches to deal with acoustic neuromas -- radiation observation and surgery.

The outcomes of scans or any tests you have had will additionally help determine the most effective course of treatment. A number of distinct specialists including could treat you:

- an ear, nose and throat (ENT) surgeon - a surgeon who specializes in treating illnesses which affect the ears, nose or throat
- a neurosurgeon - a surgeon who specializes in working on the nervous system (brain, nerves and spinal cord)
- a radiotherapist - a doctor who specializes in treatment with radiotherapy

Usually do not demonstrate signals of growing once they have been discovered. Because the tumor is quite slow-growing and benign, having a follow up MRI scan and an audiogram in 12 and 6 months is a safe choice to immediate intervention. Annual checkups later are sufficient to track the tumor if no changes are discovered. Intervention is just not required, in case the tumor doesn't reveal signs of development. The chance of the strategy is that additional long-lasting hearing loss can happen in this observation interval.

If surgery is crucial it's normally performed by means of a team composed of an otologist and a neurosurgeon. The neurosurgeon element of the tumor round the brain along with the otologist removes the element of the tumor in the ear. Hospitalization is generally for 4-7 days after surgery. Potential complications of surgery include loss of hearing and harm to the facial nerve -- the nerve that provides the face area with movement.

In case the tumor is pressing on the brainstem or shows signals of growing, surgery or radiation are crucial. The choice between the two is dependent upon lots of variables best discussed with your surgeon and radiation oncologist. Variables including as well as precise location of hearing loss, associated health problems, age, and the tumor all should be thought about.

Radiation is an option to surgery. doesn't eliminate the tumor, but a lot of times can prevent the tumor growth or cause the tumor to shrink. Radiation may be delivered in several distinct manners -- gamma knife, stereotactic radiosurgery, proton beam radiation and fractionated stereotactic surgery. The decision is manufactured with all the radiation oncologist. Potential complications of radiation include loss of facial nerve injury, hearing and ongoing increase of the tumor.

Observation

You might not have to possess some immediate treatment, when you have an acoustic neuroma that is growing very slowly or quite little. Your state will likely be cautiously tracked.

Research indicates that up to three quarters of acoustic neuromas do not seem to be growing, so tracking the tumor is all that is wanted.

Only tracking an acoustic neuroma is usually the best choice since the hazards related to surgery or radiosurgery (see below) outweigh the chance of the tumor having an adverse impact in your wellbeing.

To help track your state, you will have to possess routine magnetic resonance imaging (MRI) scans (where a magnetic field and radio waves are utilized to make a picture of the interior of your body). The MRI scan is going to be utilized to look over as well as development of your acoustic neuroma.

Other treatments could be looked at if there is a danger of your wellbeing considerably changing or in the event the tumor shows any signs of growing.

might need to have MRI scan every one or two years, although this can depend on your own general well-being as well as the size of your tumor.

Hearing loss

You may want to talk about the likelihood of having a 'bone anchored hearing aid' along with your ENT surgeon, that will help redirect sound out of your ear that is affected to your own great ear.

After surgery to eliminate an acoustic neuroma, hearing in the ear changed by the tumor is nearly always lost.

Microsurgery

Microsurgery may be used to remove an acoustic neuroma. The surgery will soon be performed under general anaesthetic, and the acoustic neuroma will be removed via an incision made in your skull.

If your little portion of the tumor stays, it may be tracked with MRI scans or efficiently treated using.

Acoustic neuromas that are little can typically be entirely removed. A tiny component will sometimes be left behind to minimize the danger of damaging the facial nerve, which runs next to the acoustic nerve should you possess a sizable tumor.

Facial nerve damage

Operation can sometimes damage the facial nerve. The reason being the acoustic nerve is extremely near the facial nerve and big tumors in many cases are stuck to it. Your surgeon with big tumors will occasionally make a little portion of the tumor on the facial nerve to attempt to sustain it and will attempt to not damage your facial nerve.

In case your facial nerve is damaged during surgery that may be found by you:

- you drool spit on the feeble side of your face
- your face droops on one side (facial palsy)
- your language is more unclear
- you've trouble shutting your eye on the feeble side of your face

These symptoms may improve within six to 12 months of getting surgery and be helped with physiotherapy. Nonetheless, it is vital that you take note that some harm to your own facial nerve could be irreversible.

After treatment, less than one in every 100 people's facial nerve will likely be badly affected in instances where the tumor is small.

Your eyes can likewise change. For instance, you could find it almost impossible to blink or close your eye entirely on the side which was operated on. As a consequence, your eye may dry out and you will need to make use of artificial tears (eye lubricant).

Any minor post-surgery facial nerve weakness will probably be temporary, even though it might take several months to recuperate.

In case a whole tumor removal is tried for big tumors, around three in 10 people may have long-lasting, serious facial nerve weakness after surgery. Approximately one man in over 100 if a tiny portion of the tumor is made on the facial nerve to maintain it.

Stereotactic radiosurgery

Stereotactic radiosurgery provides a concentrated and precise dose of radiation to your acoustic neuroma. Stereotactic means locating a point (in this particular instance the place of the tumor in your brain) using three dimensional coordinates.

It is performed under local anesthetic, meaning you will be mindful through the process but your scalp is going to be numbed. A lightweight alloy framework is normally attached to the entire scalp along with a number of scans will precisely pinpoint the location of the tumor. It may subsequently be treated utilizing a precise beam of radiation.

With no encompassing tissue, the most quantity of radiation will probably be aimed during stereotactic radiosurgery. It can get as an individual dose or delivered over several sessions. It cannot get rid of your tumor but plans to stop it growing farther. It may exclusively be utilized little tumors or the remains of a tumor after surgery on big tumors. It is not normally employed for large tumors.

Immediate negative effects of stereotactic radiosurgery are uncommon, and you will generally just have to take several days to possess the treatment.

Healing from surgery

Following surgery, you will typically have to pay as much as a week in hospital to recuperate.

You will not normally need additional treatment if your acoustic neuroma was entirely removed. Nevertheless, you will remain monitored with MRI scans.

You need to manage to come back to work after about two months. The amount of time it takes one to recuperate may be determined by as well as location of the tumor which was removed. The healthcare professionals treating you'll be in a position to guide you.