Acoustic neuroma (patient information): Difference between revisions

	Acoustic neuroma
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
When to seek urgent medical care?
Diagnosis
Treatment options
Where to find medical care for Acoustic neuroma?
Prevention of Acoustic neuroma
What to expect (Outlook/Prognosis)?
Possible complications
Acoustic neuroma On the Web
Ongoing Trials at Clinical Trials.gov
Images of Acoustic neuroma
Videos on Acoustic neuroma
FDA on Acoustic neuroma
CDC on Acoustic neuroma
Acoustic neuroma in the news
Blogs on Acoustic neuroma
Directions to Hospitals Treating Acoustic neuroma
Risk calculators and risk factors for Acoustic neuroma

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Latest revision as of 15:46, 22 May 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-in-Chief: Katherine Ogando

Overview

Acoustic neuroma, also known as vestibular schwannoma, acoustic neurinoma and acoustic neurilemoma, is a tumor that develops from schwannom cells covering vestibular nerve of inner ear to brain. The tumor is noncancerous and also usually features as slow growing one, but it may rarely have rapidly growing features and the consequences of this growth is pressure against brain and interference with vital function. The patient can be alerted about his disease by loss of hearing on one side, ringing in ears, dizziness and balance problems.

What are the symptoms of Acoustic neuroma?

Signs and symptoms of acoustic neuroma are often appear gradually and take some years to be apparent. They are not usually causes by tumor itself, although the signs and symptoms are the consequences of the tumor size and its pressure on its surrounding structures. As the tumor becomes larger in size, its pressure on nerves (facial, trigeminal and vestibular), nearby blood vessels, or other brain structure may cause more considerable or serious signs and symptoms.

Common signs and symptoms of acoustic neuroma include:

Hearing loss, often gradually - although in some cases occurs suddenly - and occurring on only one side or more pronounced on one side
Ringing (tinnitus) in the affected ear
Unsteadiness, loss of balance
Dizziness (vertigo)
Facial numbness
Weakness or loss of facial muscle movement

What causes Acoustic neuroma?

Acoustic neuroma seems to be a genetic disease that means it’s existance came from malfunctioning of a specific gene on chromosome 22. Naturally, this gene produces some proteins to regulate Schwann cell, covering nerves growth but due to some unknown reasons this gene become corrupted and its function as a Schwann cell growth regulator disturbed so they can grow uncontrollably and form a tumor. This gene malfunctioning can also come from a rarely genetical disease called Neurofibromatosis type II, that is responsible for two sided tumor.

Who is at highest risk?

As mentioned, Neurofibromatosis type II is a well-known reason of this disease, although it is responsible for only 5% of cases. Recent studies demonstrate an elevated risk of acoustic neuroma amongst individuals with the history of leisure noise exposure, but not regular occupational exposure; and a lower risk among ever and current cigarette smoker than never smokers without any correlation for ex-smokers.

When to seek urgent medical care?

You should seek medical care once each of the following symptoms are seen;

Hearing loss on one ear
Ringing in one ear
Balance disturbances

Diagnosis

Acoustic neuroma is difficult to diagnose in the primary stages since it has no signs and symptoms, unless it become lager and press against surrounding structure. Diagnosis usually triggered by patient’s symptoms. The most common symptom is unilateral hearing loss, that can be examined by audiometry tests such as “pure tone audiometry” that demonstrate progressive high frequency hearing loss.

Other diagnosing tests include:

Brain audiometry evoked response (BAER) that can measure brain response to the heard sounds.
Scalp computerized tomography (CT) scan that can be used in order to find tumor even in its first stages but it can miss very small tumor. This test mostly applied when MRI is not available or you are not comfortable with that.
Magnetic resonance imaging (MRI) is the most accurate test and it is also used to confirm the diagnosis.

Treatment options

Treatment of acoustic neuroma depends on the size and growth of the tumor. Treatment options include:

Surgery
Stereotactic radiosurgery; and
Observing

Each of mentioned above treatments options have its own privileges, for instance stereotactic radiosurgery can preserve hearing at least for several years but it can not be applied in tumor size more than about 3cm.

Observation may be a good option especially for older individuals with small tumor

Where to find medical care for Acoustic neuroma?

Directions to Hospitals Treating Acoustic neuroma

Prevention of Acoustic neuroma

Prevention of the acoustic neuroma is not possible due to the nature of the condition.

What to expect (Outlook/Prognosis)?

Acoustic neuromas are not malignant and do not metastasis (spread) to other Organs. However, some untreated or even relapsed tumor can grow rapidly and invade surrounding structure such as nerves, ear and brain tissue, especially brain stem which is life-treating. Even after adequate treatment by surgery or radiation some complications such as hearing loss and balance problems caused by tumor may be persistent. The least permanent complication are seen when the tumor discovered in its primary stages when its really small therefore its more likely to preserve hearing.

Possible complications

Since each treatment option is chosen, vary of complication is expected such as:
- Hearing loss
- Facial numbness
- Facial weakness
- Ringing in ear
- Balance problems
- Persistent headache
- Stroke or brain bleeding
- Infection of cerebrospinal fluid (Meningitis)
- Leakage of cerebrospinal fluid from the wound (may occur only after surgery)

Sources

References

Template:WH Template:WS

@@ Line 6: / Line 6: @@
 ==Overview==
-An [[acoustic neuroma]] (also known as '''[[vestibular schwannoma]]''', '''[[acoustic neurinoma]]''', or '''[[acoustic neurilemoma]]''') is a benign, usually slow-growing tumor that develops from the balance and hearing nerves supplying the inner ear.
+Acoustic neuroma, also known as [[Acoustic neuroma|vestibular schwannoma]], [[Acoustic neuroma|acoustic neurinoma]] and [[Acoustic neuroma|acoustic neurilemoma]], is a tumor that develops from [[Schwann cell|schwannom cells]] covering [[vestibular nerve]] of [[inner ear]] to brain. The tumor is noncancerous and also usually features as slow growing one, but it may rarely have rapidly growing features and the consequences of this growth is pressure against brain and interference with vital function. The patient can be alerted about his disease by [[Hearing loss|loss of hearing]] on one side, [[Tinnitus|ringing in ears]], [[dizziness]] and [[Disequilibrium|balance problems]].
 ==What are the symptoms of Acoustic neuroma?==
-As the acoustic neuroma grows, it presses against the hearing and balance [[nerves]], usually causing unilateral (one-sided) or asymmetric [[hearing loss]], [[tinnitus]] (ringing in the ear), and [[dizziness]]/loss of balance. As the [[tumor]] grows, it can interfere with the face sensation nerve (the [[trigeminal nerve]]), causing facial numbness. Acoustic neuromas can also press on the facial nerve (for the muscles of the face) causing facial weakness or [[paralysis]] on the side of the tumor. If the tumor becomes large, it will eventually press against nearby brain structures (such as the [[brain stem]] and the [[cerebellum]]), becoming life-threatening.
+Signs and symptoms of acoustic neuroma are often appear gradually and take some years to be apparent. They are not usually causes by tumor itself, although the signs and symptoms are the consequences of the tumor size and its pressure on its surrounding structures. As the tumor becomes larger in size, its pressure on nerves ([[Facial nerve|facial]], [[Trigeminal nerve|trigeminal]] and [[Vestibular nerve|vestibular]]), nearby blood vessels, or other brain structure may cause more  considerable or serious signs and symptoms.
-[[Neurofibromatosis]] may present with similar symptoms.
+Common signs and symptoms of acoustic neuroma include:
+* [[Hearing loss]], often gradually - although in some cases occurs suddenly - and occurring on only one side or more pronounced on one side
+* Ringing ([[tinnitus]]) in the affected ear
+* [[Disequilibrium|Unsteadiness]], loss of balance
+* [[Dizziness]] ([[vertigo]])
+* Facial numbness
+* Weakness or loss of facial muscle movement
 ==What causes Acoustic neuroma?==
-Acoustic neuroma can appear either sporadically or as [[neurofibromatosis type II]] (NF2), a rare inherited syndrome.<ref>http://www.dizziness-and-balance.com/disorders/tumors/acoustic_neuroma.htm</ref>
+Acoustic neuroma seems to be a [[Genetic disorder|genetic disease]] that means it’s existance came from malfunctioning of a specific gene on [[chromosome]] 22. Naturally, this gene produces some proteins to regulate [[Schwann cell]], covering nerves growth but due to some unknown reasons this gene become corrupted and its function as a [[Schwann cell]] growth regulator disturbed so they can grow uncontrollably and form a tumor. This gene malfunctioning can also come from a rarely [[Genetic disorder|genetical disease]] called [[Neurofibromatosis type II]], that is responsible for two sided tumor.
-The tumor develops from an overproduction of [[Schwann cells]] (the cells that normally wrap around nerve fibers like onion skin to help support and insulate nerves.)
 ==Who is at highest risk?==
-Acoustic neuromas are more common in adults, and rarely occur in children. <ref>http://www.dizziness-and-balance.com/disorders/tumors/acoustic_neuroma.htm</ref>
+As mentioned, [[Neurofibromatosis type II]] is a well-known reason of this disease, although it is responsible for only 5% of cases. Recent studies demonstrate an elevated risk of acoustic neuroma amongst individuals with the history of leisure noise exposure, but not regular occupational exposure; and a lower risk among ever and current cigarette smoker than never smokers without any correlation for ex-smokers.
 ==When to seek urgent medical care?==
-You should seek medical care once [[hearing loss]], [[dizziness]], and [[tinnitus]] symptoms appear. Pay special attention to unilateral or asymmetric symptoms.
+You should seek medical care once each of the following symptoms are seen;
+* [[Hearing impairment|Hearing loss]] on one ear
+* [[Tinnitus|Ringing]] in one ear
+* [[Disequilibrium|Balance disturbances]]
 ==Diagnosis==
-Unilateral/asymmetric hearing loss and/or [[tinnitus]] and loss of balance/[[dizziness]] are early signs of an acoustic neuroma. Unfortunately, early detection of the tumor is sometimes difficult because the symptoms may be subtle and may not appear in the beginning stages of growth. Also, [[hearing loss]], [[dizziness]], and [[tinnitus]] are common symptoms of many [[middle ear|middle]] and [[inner ear]] problems (the important point here is that unilateral or asymmetric symptoms are the worrisome ones). Once the symptoms appear, a thorough ear examination and hearing test ([[audiogram]]) are essential for proper diagnosis. [[Computerized tomography]] (CT) scans, enhanced with intravenous dye (contrast), and [[magnetic resonance imaging]] (MRI) are critical in the early detection of a acoustic neuroma and are helpful in determining the location and size of a tumor and in planning its microsurgical removal.
+Acoustic neuroma is difficult to diagnose in the primary stages since it has no signs and symptoms, unless it become lager and press against surrounding structure. Diagnosis usually triggered by patient’s symptoms. The most common symptom is unilateral [[Hearing impairment|hearing loss]], that can be examined by audiometry tests such as “'''[[pure tone audiometry]]'''” that demonstrate progressive high frequency hearing loss.
+Other diagnosing tests include:
+* '''[[Auditory brainstem response|Brain audiometry evoked response]] ([[Auditory brainstem response|BAER]])''' that can measure brain response to the heard sounds.
+* '''[[Computed tomography|Scalp computerized tomography (CT) scan]]''' that can be used in order to find tumor even in its first stages but it can miss very small tumor. This test mostly applied when MRI is not available or you are not comfortable with that.
+* '''[[Magnetic resonance imaging]] ([[Magnetic resonance imaging|MRI]])''' is the most accurate test and it is also used to confirm the diagnosis.''' '''
 ==Treatment options==
-Early diagnosis of an acoustic neuroma is key to preventing its serious consequences. There are three options for managing acoustic neuroma:
+Treatment of acoustic neuroma depends on the size and growth of the tumor. Treatment options include:
-*surgical removal
+* [[Surgery]]
-*radiation; and
+* Stereotactic [[radiosurgery]]; and
-*monitoring
+* Observing
+Each of mentioned above treatments options have its own privileges, for instance stereotactic radiosurgery can preserve hearing at least for several years but it can not be applied in tumor size more than about 3cm.
-Typically, the tumor is surgically removed (excised). The exact type of operation done depends on the size of the tumor and the level of hearing in the affected ear. If the [[tumor]] is very small, hearing may be saved and accompanying symptoms may improve. As the tumor grows larger, surgical removal is more complicated because the tumor may have damaged the [[nerves]] that control facial movement, hearing, and balance and may also have affected other nerves and structures of the brain.
+Observation may be a good option especially for older individuals with small tumor
-The removal of tumors affecting the hearing, balance, or facial nerves can make the patient's symptoms worse because sections of these nerves may also need to be removed with the tumor.
-As an alternative to conventional surgical techniques, [[radiosurgery]] (that is, radiation therapy--the "gamma knife" or LINAC) may be used to reduce the size or limit the growth of the tumor. [[Radiation therapy]] is sometimes the preferred option for elderly patients, patients in poor medical health, patients with bilateral acoustic neuroma (tumor affecting both ears), or patients whose tumor is affecting their only hearing ear. In some cases, usually elderly or medically infirm patients, it may be reasonable to "watch" the tumor for growth. Repeat MRI over time is used to carefully monitor the tumor for any growth.
 ==Where to find medical care for Acoustic neuroma?==
@@ Line 43: / Line 51: @@
 ==Prevention of Acoustic neuroma==
-There is no known prevention of acoustic neuroma.
+Prevention of the acoustic neuroma is not possible due to the nature of the condition.
 ==What to expect (Outlook/Prognosis)?==
-The prognosis is positive when the acoustic neuroma is diagnosed and treated promptly.  It is not uncommon to still experience [[tinnitis]] and long-term [[hearing loss]] after treatment.  You might be required to undergo treatment multiple times as there is always a possibility for the tumor to grow back.
+Acoustic neuromas are not [[malignant]] and do not [[metastasis]] (spread) to other Organs. However, some untreated or even relapsed tumor can grow rapidly and invade surrounding structure such as nerves, ear and brain tissue, especially [[brain stem]] which is life-treating. Even after adequate treatment by surgery or radiation some complications such as [[Hearing impairment|hearing loss]] and [[Disequilibrium|balance problems]] caused by tumor may be persistent. The least permanent complication are seen when the tumor discovered in its primary stages when its really small therefore its more likely to preserve hearing.
 ==Possible complications==
-* Brain surgery can completely remove the tumor in most cases.
+* Since each treatment option is chosen, vary of complication is expected such as:
-* Most people with small tumors will have no permanent paralysis of the face after surgery. However, about two-thirds of patients with large tumors will have some permanent facial weakness after surgery.
+** [[Hearing impairment|Hearing loss]]
-* Approximately one-half of patients with small tumors will still be able to hear well in the affected ear after surgery.
+** Facial numbness
-* There may be delayed radiation effects after radiosurgery, including nerve damage, loss of hearing, and paralysis of the face.
+** [[Facial weakness]]
+** [[Tinnitus|Ringing]] in ear
+** [[Disequilibrium|Balance problems]]
+** Persistent [[headache]]
+** [[Stroke]] or brain bleeding
+** Infection of cerebrospinal fluid ([[Meningitis]])
+** Leakage of cerebrospinal fluid from the wound (may occur only after surgery)
 ==Sources==
@@ Line 59: / Line 73: @@
 * [http://www.nlm.nih.gov/medlineplus/ency/article/000778.htm Medline Plus]
-[[Category:Mature chapter]]
+==References==
+{{reflist|2}}
+{{WH}}
+{{WS}}
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 [[Category:Otolaryngology patient information]]
+ [[Category:Up-To-Date]]
-{{WH}}
+[[Category:Oncology]]
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+[[Category:Medicine]]
+[[Category:Otolaryngology]]
+[[Category:Neurology]]
+[[Category:Neurosurgery]]