From the Guidelines
For vertigo associated with schwannoma, medications like meclizine (25-50 mg every 4-6 hours), diazepam (2-5 mg every 6-8 hours), or promethazine (25 mg every 4-6 hours) can help manage symptoms by reducing the sensation of spinning. Unfortunately, there are currently no medications proven to stop hearing loss caused by schwannoma, as the hearing loss occurs because the tumor presses on the vestibulocochlear nerve, causing progressive damage that medications cannot prevent 1. Steroids like prednisone (typically 60 mg daily for 7-10 days with a taper) may temporarily help with sudden hearing loss in some cases, but won't provide long-term protection 1.
Key Considerations
- The definitive treatment for schwannoma involves either surgical removal or radiation therapy to control tumor growth and prevent further nerve damage 1.
- Regular monitoring with MRI scans and hearing tests is essential to track tumor progression 1.
- While waiting for definitive treatment, avoiding loud noises and using hearing aids may help manage existing hearing loss, though they won't prevent further deterioration if the tumor continues to grow 1.
Management of Vertigo and Hearing Loss
- Medications for vertigo: meclizine, diazepam, or promethazine 1.
- No medications proven to stop hearing loss caused by schwannoma 1.
- Steroids like prednisone may temporarily help with sudden hearing loss in some cases 1.
- Definitive treatment: surgical removal or radiation therapy 1.
Importance of Early Diagnosis and Monitoring
- Early diagnosis of vestibular schwannoma is associated with smaller tumor size, which may have advantages regardless of the management strategy 1.
- Regular monitoring with MRI scans and hearing tests is essential to track tumor progression and optimize quality of life 1.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. There is no information about preventing hearing loss in the provided drug labels.
- Meclizine is used to treat vertigo associated with diseases affecting the vestibular system, which includes vestibular schwannoma (acoustic neuroma) 2, 2. However, the provided drug labels do not mention the prevention of hearing loss.
From the Research
Treatment for Vertigo and Hearing Loss in Vestibular Schwannoma
- The current treatments for vestibular schwannoma include observation, microsurgical resection, or stereotactic radiation, which may prevent catastrophic brainstem compression but are associated with the loss of cranial nerve function, particularly hearing loss 3.
- Novel targeted treatment options to stop tumor progression include small molecule inhibitors, immunotherapy, anti-inflammatory drugs, radio-sensitizing and sclerosing agents, and gene therapy 3.
- Gamma knife radiosurgery (GKRS) is suggested to be the most ideal treatment for vestibular schwannoma based on stabilizing hearing capability, increasing hearing capability, decreasing tumor size, and complications 4.
Medication for Vertigo and Hearing Loss
- Steroid treatment is considered for sudden sensorineural hearing loss in patients with vestibular schwannoma, with a recovery rate of 34.3% showing good recovery and significant improvements in pure-tone audiometry values 5.
- The use of steroids may be beneficial in patients with vestibular schwannoma presenting with sudden sensorineural hearing loss, regardless of age, initial hearing level, presence of vertigo, tumor size, and tumor extension 5.
Hearing Rehabilitation Options
- Various devices are available for hearing rehabilitation in patients with vestibular schwannoma, including contralateral routing of hearing signals (CROS), bone-anchored hearing devices, auditory brainstem implants (ABI), and cochlear implants 6, 7.
- Conventional hearing aids, CROS aids, and bone-anchored hearing aids (BAHA) are viable options for rehabilitating hearing impairment in vestibular schwannoma patients, but require an accurate case-by-case audiological evaluation 7.