What are acoustic neuromas?

An acoustic neuroma is also called a vestibular schwannoma. This is because it starts in cells called Schwann cells. Schwann cells cover and support the hearing and balance nerve.

An acoustic neuroma is not cancer (malignant). It is a benign tumour. A benign tumour can cause problems as it grows by pressing on surrounding tissue. But, unlike cancer, it cannot spread from where it started to other parts of the brain.

Acoustic neuromas develops from the lining of the main nerve that connects the inner ear to your brain. This is called the acoustic or vestibulocochlear nerve and it controls your hearing and balance. The main nerve that controls facial movement runs next to it. Although acoustic neuromas are a type of brain tumour, they do not spread into the brain. But if a tumour grows large enough, it can affect nearby nerves or important functions of the brain.

Symptoms of acoustic neuroma

Acoustic neuromas are usually slow growing. Symptoms often develop gradually over several years.

Common symptoms include:

  • loss of hearing in the affected ear
  • hearing a buzzing or ringing noise (tinnitus)
  • feeling dizzy
  • problems with balance.

If the tumour presses on nearby nerves affecting the face, it can cause numbness, tingling or weakness on one side of the face. Rarely, larger tumours may lead to increased pressure on the brain. This may cause headaches and changes to your eyesight. Other rare symptoms include difficulty swallowing and voice changes.

Causes of acoustic neuroma

Acoustic neuromas are most common in people aged between 40 and 60, but they can affect people of any age.

The cause of acoustic neuromas is unknown, but research is being done to find out more.

In a small number of people, acoustic neuromas are linked to an inherited (genetic) condition called neurofibromatosis type 2 (NF2). In this situation, tumours usually develop on the hearing and balance nerves on both sides of the head.

People who had radiation for head and neck conditions as a child may have an increased risk of developing acoustic neuroma.

We have more information about [risk factors and causes of brain tumours.

Diagnosis of acoustic neuroma

Your doctors need to find out as much as possible about the type, position and size of the tumour so they can plan your treatment. You may have tests to check:

  • your hearing
  • your sense of balance
  • your reflexes and the power and feeling in your arms and legs

You will also have an MRI scan to find out the exact position and size of the tumour. If you cannot have an MRI scan, you may have a CT scan.

Getting support

Being diagnosed with a brain tumour can make you feel shocked, frightened, angry or upset. There is no right or wrong way to feel. Talking about your feelings can often help. The British Acoustic Neuroma Association also has more information about coping with this type of tumour.

How diagnosis affects your right to drive

You do not need to tell a licensing agency that you have been diagnosed with an acoustic neuroma, unless you experience sudden dizziness.

If you experience sudden dizziness, you must contact the agency in your country:

  • for England, Scotland and Wales, contact the DVLA on 0300 790 6806
  • for Northern Ireland, contact the DVA on 0300 200 7861.

If you have to stop driving, the DVLA or DVA will tell you when you are allowed to start driving again. They may ask you if they can get medical information about you from your doctor.

Treatment for acoustic neuroma

Your treatment may depend on:

  • the size of the tumour
  • how the symptoms are affecting you
  • your general health.

If the tumour is small and causing mild symptoms, your doctor may suggest active monitoring until treatment is needed. If treatment is needed, the main treatments for acoustic neuromas are radiotherapy or surgery.

A team of specialists will plan your treatment. Your specialist doctor and nurse will explain the aims of your treatment and what it involves. They will talk to you about the benefits and disadvantages of different treatment types. They will also explain the risks and side effects.

You may be given a choice of treatment options. You will have time to talk about this with your hospital team before you make any treatment decisions.

You will need to give permission (consent) for the hospital staff to give you the treatment. Ask any questions about anything you do not understand or feel worried about. Tell your specialist if you need more information or more time to decide on a treatment.

Active monitoring

Active monitoring means regularly checking the tumour to find out if it is growing.

If the tumour is small and the symptoms are mild, your doctor may suggest delaying treatment until it is needed. This is because treatment can cause side effects and some of these may be permanent.

Instead of starting treatment, you may see your specialist doctor regularly to have scans to check for changes in the size of the tumour. This can help your doctor know if and when to recommend treatment. Because acoustic neuromas are often slow growing and sometimes do not grow at all, it may be a long time before your symptoms change.

Talk to your specialist doctor if you are worried about any symptoms. They will explain the benefits and risks of active monitoring.

Radiotherapy

Radiotherapy uses high-energy rays to destroy the tumour cells. You may have radiotherapy to stop a tumour growing. Sometimes it can also shrink it.

Acoustic neuromas are usually treated with a type of radiotherapy called stereotactic radiotherapy (SRT). There are different ways of giving SRT with different radiotherapy machines. The radiotherapy machine directs radiation beams from different angles so they cross over at the tumour. This gives a high dose of radiation to the tumour and lower doses to nearby healthy areas. This lowers the risk of damage to normal cells and can sometimes reduce side effects.

You may have stereotactic radiotherapy:

  • as a single treatment – this is called stereotactic radiosurgery (SRS) and it is often used to treat smaller tumours
  • over 3 to 10 sessions, spread over 2 weeks.

If you do not have SRT, you may have external beam radiotherapy. This is usually given daily, from Monday to Friday, for 5 to 6 weeks.

Your specialist doctor will explain how long treatment will last and the type of radiotherapy you will have.

Side effects of radiotherapy

You may develop side effects during or after your treatment. Side effects can depend on which area of the brain has been treated and the amount of radiotherapy given.

Your radiotherapy team will explain the possible side effects of the treatment. Some side effects are mild and quite easy to cope with. Others may be managed with drugs or other treatments. It is normal to feel tired after treatment. This usually improves over time.

Tell your radiotherapy team straight away if your side effects get worse during or after treatment. They can give you advice on how to manage them.

Sometimes, radiotherapy for acoustic neuroma can cause long-term or permanent side effects that develop months or years later. These can include hearing loss and, rarely, damage to the nerves that affect your face.

We have more information about radiotherapy to the brain and possible side effects.

Surgery

Surgery for acoustic neuromas involves removing all or part of the tumour. Sometimes the surgeon leaves a small part of the tumour to avoid damaging nearby nerves. You may have stereotactic radiosurgery (SRS) or radiotherapy after surgery.

Your surgeon will explain the surgery and the possible risks. They will give you information about what to expect before and after your operation. The doctors and nurses will monitor you carefully after your operation.

Side effects of surgery

Surgery is likely to have more immediate side effects than radiosurgery or stereotactic radiotherapy.

Surgery usually causes hearing loss in the affected ear. If you have hearing loss after your treatment, you may be able to get a hearing aid. You will usually see a hearing specialist (audiologist) or ear, nose and throat (ENT) specialist for expert help and advice.

Sometimes, surgery damages the facial nerve. This can cause drooping (palsy) of one side of the face. This is usually temporary. It can affect actions like chewing and blinking. It can take time for the facial nerve to recover.

Some people also get a dry eye. Eye drops will help with this. If needed, your doctor can refer you to an eye specialist. You may:

  • have headaches
  • have nausea
  • feel dizzy
  • notice that your balance is affected.

These usually improve in the weeks after surgery.

You may also feel very tired. It can take 2 to 3 months to start to feel better.

We have more information about help with recovering from surgery.

After acoustic neuroma treatment

After your treatment has finished, you will have regular check-ups, tests and scans.

Some side effects can start months or years after treatment has finished. You can use your follow-up appointments to talk about these side effects, or about any other worries or problems you have.

Many people find they get very anxious before appointments. This is natural. It may help to get support from family, friends or a specialist nurse.

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