An acoustic neuroma, also called vestibular schwannoma, is a slow-growing benign tumor of the sheath of the vestibulocochlear nerve. It typically causes hearing loss in one ear, and when large it can press on nearby nerves and the brainstem.
Key symptoms
- Gradual hearing loss in one ear
- Ringing (tinnitus) in the same ear
- Unsteadiness more than true spinning vertigo
- Facial numbness or, rarely, facial weakness with larger tumors
- Headache with very large tumors
What you find on exam
- Otoscopy usually normal
- Weber lateralizes to the good ear; Rinne positive on both sides (sensorineural loss)
- Cranial nerves V and VII: corneal reflex and facial strength
- Gait, balance and cerebellar signs
Tests
- Audiogram: asymmetric sensorineural hearing loss with poor word recognition
- MRI of the internal auditory canals with gadolinium, the test of choice
- Auditory brainstem response if MRI cannot be done
- Look for tumors on both sides (neurofibromatosis type 2) in young patients
Treatment basics
- Small, stable tumor: watch with serial MRI and hearing tests
- Stereotactic radiosurgery for small to medium growing tumors
- Microsurgical removal for large tumors or brainstem compression
- Hearing rehabilitation: hearing aids or implant options
Red flags
- Sudden one-sided hearing loss, which needs urgent assessment
- Facial weakness, worsening facial numbness or trouble swallowing
- Headache, vomiting or vision changes suggesting raised intracranial pressure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.