Acoustic Neuroma
A benign, slow-growing tumor on the nerve connecting the inner ear to the brain, which commonly causes one-sided hearing loss, ringing in the ear, and balance problems.
Quick Answer
An acoustic neuroma, also called a vestibular schwannoma, is a benign, slow-growing tumor on the nerve that connects the inner ear to the brain. It typically causes gradual, one-sided hearing loss, ringing in the ear (tinnitus), and imbalance. Because it grows slowly, options include monitoring, stereotactic radiosurgery, and microsurgical removal, chosen based on tumor size, hearing, and symptoms.
Key Takeaways
- An acoustic neuroma is a benign tumor on the hearing and balance nerve.
- The classic symptom is gradual, one-sided hearing loss with ringing.
- It grows slowly, so observation is an option for many small tumors.
- Stereotactic radiosurgery controls many tumors without an incision.
- Microsurgery is used for larger tumors, aiming to preserve nerve function.
At a Glance
| What it is | Benign tumor on the vestibulocochlear (hearing and balance) nerve |
|---|---|
| Classic symptoms | One-sided hearing loss, tinnitus, imbalance |
| Growth | Usually slow |
| Diagnosis | MRI with contrast and hearing tests |
| Options | Observation, radiosurgery, or microsurgery |
| Goals | Control the tumor while preserving hearing and facial nerve function |
Symptoms
The most common symptom is gradual hearing loss in one ear, often accompanied by ringing in that ear (tinnitus) and a sense of imbalance or unsteadiness. Because the loss is gradual and one-sided, it may be noticed as difficulty using the phone on one side or understanding speech in noisy settings.
As a tumor enlarges, it can affect nearby nerves and structures, potentially causing facial numbness or, less commonly, facial weakness, and in large tumors, symptoms from pressure on the brainstem. Sudden hearing loss can also occur and should be evaluated.
Common Warning Signs
- Gradual hearing loss in one ear
- Ringing (tinnitus) in one ear
- Imbalance or unsteadiness
- A feeling of fullness in one ear
- Facial numbness (larger tumors)
When to Seek Care Promptly
- Sudden hearing loss in one ear
- New facial weakness
- Worsening balance with headache
- Double vision or difficulty swallowing
- Rapidly progressing symptoms
Diagnosis
Evaluation typically includes a hearing test (audiogram), which often shows one-sided hearing loss, and MRI with contrast, which is the most sensitive imaging study for detecting acoustic neuromas and evaluating the hearing and balance nerve.
The tumor’s size and location, along with the degree of hearing loss and other symptoms, guide the discussion of treatment options. Because these tumors grow slowly, there is usually time to consider the choices carefully.
Treatment
Because acoustic neuromas are benign and slow-growing, small tumors with stable symptoms may be monitored with periodic MRI and hearing tests. This avoids treatment for tumors that may grow little or not at all over time.
When treatment is needed, stereotactic radiosurgery delivers focused radiation to control tumor growth without an incision and is well suited to selected small and medium tumors. Microsurgery may be recommended based on factors such as tumor size, growth, symptoms, hearing status, age, and overall health. When surgery is appropriate, careful attention is given to preserving neurological function, particularly the facial nerve and, when possible, hearing.
At Atlantic Brain and Spine, the skull base team, often working with neurotology, tailors the approach to the individual.
The Diagnosis-to-Treatment Pathway
1. Hearing evaluation
An audiogram documents one-sided hearing loss.
2. MRI
Contrast MRI confirms and sizes the tumor.
3. Assessment
Size, hearing, and symptoms guide the options.
4. Observation if appropriate
Small, stable tumors may be monitored.
5. Radiosurgery
Focused radiation controls suitable tumors without incision.
6. Microsurgery
Larger tumors are removed with nerve preservation in mind.
7. Follow-up
Imaging and hearing tests monitor over time.
Frequently Asked Questions
It is a benign, slow-growing tumor that develops on the vestibulocochlear nerve, which connects the inner ear to the brain and carries hearing and balance information. It is also called a vestibular schwannoma. Although benign, it can affect hearing, balance, and, if large, nearby structures.
The most common early symptom is gradual hearing loss in one ear, often with ringing (tinnitus) and a sense of imbalance. Because these develop slowly and on one side, they may be subtle at first. Sudden one-sided hearing loss can also occur and should be evaluated.
Many small acoustic neuromas with stable symptoms are safely monitored with periodic MRI and hearing tests, since they grow slowly. Treatment is considered when a tumor grows, causes significant symptoms, or is large. The choice among observation, radiosurgery, and surgery is individualized.
The facial nerve runs very close to these tumors, so preserving its function is a central goal of treatment. The risk depends on tumor size and the treatment used, and it is monitored closely during surgery. Your surgeon will give you a specific assessment based on your tumor.
Treatment aims to control the tumor and preserve existing hearing when possible, but it does not usually restore hearing that has already been lost. Hearing preservation depends on the tumor size, your current hearing, and the treatment approach, which your team will discuss with you.
Both are effective, and the best choice depends on the tumor’s size, your hearing, your symptoms, and your preferences. Radiosurgery controls many small and medium tumors without an incision, while microsurgery removes larger tumors. The skull base team helps you weigh the options.
Specialists Who Treat Acoustic Neuromas
Your care is provided by Atlantic Brain and Spine's skull base team, including fellowship-trained neurosurgeons.
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