What are the symptoms and treatment options for acoustic neuroma?

From the Guidelines

Acoustic neuromas typically present with gradual hearing loss in one ear, often accompanied by tinnitus (ringing) and problems with balance or dizziness, and treatment options depend on tumor size, growth rate, and patient factors, with stereotactic radiosurgery being a suitable option for tumors under 3cm 1.

Symptoms of Acoustic Neuroma

The symptoms of acoustic neuroma include:

• Unilateral sensorineural hearing loss (94%) 1
• Tinnitus (83%) 1
• Vestibular symptoms such as vertigo and unsteadiness (17-75% of patients) 1
• Facial numbness, facial weakness, headaches, and difficulty swallowing in advanced cases

Treatment Options

Treatment options for acoustic neuroma include:

• Watchful waiting with regular MRI scans, especially for small, slow-growing tumors in older patients or those with minimal symptoms 1
• Stereotactic radiosurgery (such as Gamma Knife) to stop tumor growth while preserving hearing and facial nerve function, suitable for tumors under 3cm 1
• Traditional surgery to remove the tumor completely, with risks of hearing loss and facial nerve damage, and the choice of surgical approach depending on tumor characteristics, patient age, and overall health 1

Recommendation

The choice between observation, radiation, and surgery should be individualized based on tumor characteristics, patient age, overall health, and symptom severity, with early diagnosis through MRI imaging crucial for preserving hearing and minimizing complications 1. Some key points to consider when making a decision include:

• Tumor size and growth rate
• Patient age and overall health
• Symptom severity and impact on quality of life
• The potential risks and benefits of each treatment option
• The importance of preserving hearing and facial nerve function

Recent Guidelines

Recent guidelines from the International Stereotactic Radiosurgery Society recommend upfront stereotactic radiosurgery as an effective treatment for achieving tumor control with similar rates of hearing preservation, and conservative surveillance as the recommended approach for older patients with no appreciable tumor growth regardless of hearing status 1.

From the Research

Acoustic Neuroma Symptoms

• Unilateral sensorineural hearing loss, tinnitus, dizziness, facial and/or trigeminal neuropathy are common symptoms of acoustic neuroma 2
• Atypical symptoms, such as facial numbness or pain, sudden onset of hearing loss, and orofacial paresthesia, can also occur in about 10% of patients 3
• Other symptoms may include:
  • Unsteadiness and dysequilibrium 4
  • Headaches 5
  • Trigeminal paresthesia and recurrent headache 5
  • Profound hearing loss and recent onset of unsteadiness 5

Treatment Options

• Watchful waiting, microsurgical resection, and stereotactic radiation are available treatment options for acoustic neuroma 2
• The choice of treatment depends on various factors, including age, health, hearing, size, location, and growing status of the tumor 2
• Microsurgery and radiosurgery are two major treatment options, with radiosurgery being associated with a lower rate of immediate and long-term development of facial and trigeminal neuropathy, postoperative complications, and hospital stay 6
• Radiosurgery yields better measurable hearing preservation than microsurgery and equivalent serviceable hearing preservation rate and tumor growth control 6

Diagnostic Evaluation

• Routine audiometry and special audiometric tests, such as acoustic reflex tests and brainstem-evoked response, can provide objective information about hearing loss 4
• Computed tomography with dye enhancement and magnetic resonance imaging (MRI) are accurate diagnostic tests for acoustic neuroma 4
• BAEPs and gadolinium-enhanced MRI can be used to evaluate patients with atypical presentations 5