Acoustic neuroma ear exam at Mayo Clinic
A thorough physical exam, including an ear exam, is often the first step in acoustic neuroma diagnosis and treatment.
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Acoustic neuroma is often difficult to diagnose in the early stages because signs and symptoms may be easy to miss and develop slowly over time. Common symptoms such as hearing loss are also associated with many other middle and inner ear problems.
After asking questions about your symptoms, your doctor will conduct an ear exam. Your doctor may order the following tests:
Hearing test (audiometry). In this test, conducted by a hearing specialist (audiologist), you hear sounds directed to one ear at a time. The audiologist presents a range of sounds of various tones and asks you to indicate each time you hear the sound. Each tone is repeated at faint levels to find out when you can barely hear.
The audiologist may also present various words to determine your hearing ability.
- Imaging. Magnetic resonance imaging (MRI) with contrast dye is usually used to diagnose acoustic neuroma. This imaging test can detect tumors as small as 1 to 2 millimeters in diameter. If MRI is unavailable or you can't have an MRI scan for some reason, computerized tomography (CT) may be used. However, CT scans may miss very small tumors.
Acoustic neuroma surgery at Mayo Clinic
Surgical removal of the tumor by an experienced neurosurgeon is one of the acoustic neuroma treatment options at Mayo Clinic.
Your acoustic neuroma treatment may vary, depending on:
- The size and growth of the acoustic neuroma
- Your overall health
- Severity of symptoms
To treat acoustic neuroma, your doctor may suggest one or more of three potential options: monitoring, surgery or radiation therapy.
If you have a small acoustic neuroma that isn't growing or is growing slowly and causes few or no signs or symptoms, you and your doctor may decide to monitor it. Monitoring may be recommended if you're an older adult or otherwise not a good candidate for more-aggressive treatment.
Your doctor may recommend that you have regular imaging and hearing tests, usually every 6 to 12 months, to determine whether the tumor is growing and how quickly. If the scans show the tumor is growing or if the tumor causes progressive symptoms or other difficulties, you may need to undergo treatment.
You may need surgery to remove an acoustic neuroma, especially if the tumor is:
- Continuing to grow
- Very large
- Causing symptoms
Your surgeon may use one of several techniques for removing an acoustic neuroma, depending on the size of your tumor, hearing status and other factors.
The goal of surgery is to remove the tumor and preserve the facial nerve to prevent facial paralysis. Removing the entire tumor may not be possible in certain cases — for example, if the tumor is too close to important parts of the brain or the facial nerve.
Surgery for an acoustic neuroma is performed under general anesthesia and involves removing the tumor through the inner ear or through a window in your skull.
Sometimes, surgical removal of the tumor may worsen symptoms if the hearing, balance, or facial nerves are irritated or damaged during the operation. Hearing may be lost on the side where the surgery is performed, and balance is usually affected temporarily.
Complications may include:
- Leaking cerebrospinal fluid through the wound or nose
- Hearing loss
- Facial weakness or numbness
- Ringing in the ear
- Balance problems
- Persistent headache
- Rarely, infection of the cerebrospinal fluid (meningitis)
- Very rarely, stroke or brain bleeding
Gamma Knife stereotactic radiosurgery
Gamma Knife stereotactic radiosurgery technology uses many small gamma rays to deliver a precise dose of radiation to a target.
There are several types of radiation therapy used to treat acoustic neuroma:
Stereotactic radiosurgery. Your doctor may recommend a type of radiation therapy known as stereotactic radiosurgery. It's often used if your tumor is small (less than 2.5 centimeters in diameter), you are an older adult or you cannot tolerate surgery for health reasons.
Stereotactic radiosurgery, such as Gamma Knife radiosurgery, uses many tiny gamma rays to deliver a precisely targeted dose of radiation to a tumor without damaging the surrounding tissue or making an incision.
The goal of stereotactic radiosurgery is to stop the growth of a tumor, preserve the facial nerve's function and possibly preserve hearing.
It may take weeks, months or years before you notice the effects of radiosurgery. Your doctor will monitor your progress with follow-up imaging studies and hearing tests.
Risks of radiosurgery include:
- Hearing loss
- Ringing in the ear
- Facial weakness or numbness
- Balance problems
- Continued tumor growth
- Stereotactic radiotherapy. Fractionated stereotactic radiotherapy (SRT) delivers a small dose of radiation to the tumor over several sessions. SRT is done to curb the growth of the tumor without damaging surrounding brain tissue.
- Proton beam therapy. This type of radiation therapy uses high-energy beams of positively charged particles called protons. Protons are delivered to the affected area in targeted doses to treat tumors and minimize radiation exposure to the surrounding area.
In addition to treatment to remove or stop the growth of the tumor, your doctor may recommend supportive therapies to address symptoms or complications of an acoustic neuroma and its treatment, such as dizziness or balance problems.
Cochlear implants or other treatments may also be recommended to treat hearing loss.
Supportive care for acoustic neuroma at Mayo Clinic
Supportive care including balance (vestibular) therapy, physical therapy, occupational therapy and hearing assistance is part of the comprehensive acoustic neuroma treatment at Mayo Clinic.
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Coping and support
Dealing with the possibility of hearing loss and facial paralysis and deciding which treatment would be best for you can be quite stressful. Here are some suggestions you may find helpful:
- Educate yourself about acoustic neuroma. The more you know, the better prepared you'll be to make good choices about treatment. Besides talking to your doctor and your audiologist, you may want to talk to a counselor or social worker. Or you may find it helpful to talk to other people who've had an acoustic neuroma and learn more about their experiences during and after treatment.
Maintain a strong support system. Family and friends can help you as you go through this difficult time. Sometimes, though, you may find the concern and understanding of other people with acoustic neuroma especially comforting.
Your doctor or a social worker may be able to put you in touch with a support group. Or you may find an in-person or online support group through the Acoustic Neuroma Association.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. Your doctor may then refer you to a doctor trained in ear, nose and throat conditions or a doctor trained in brain and nervous system surgery (neurosurgeon).
Because there's often a lot to talk about during your appointment, it's a good idea to be well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Make a list of all medications, vitamins or supplements that you're taking.
- Ask a family member or friend to join you, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Preparing a list of questions will help you make the most of your time with your doctor. For acoustic neuroma, some basic questions to ask your doctor include:
- What is likely causing my symptoms?
- Are there any other possible causes for my symptoms?
- What kinds of tests do I need?
- What treatment options are available?
- Which one do you recommend for me?
- What is the likelihood of side effects from each treatment option?
- What happens if I do nothing?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What you can expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Do you have any family members with an acoustic neuroma?
- At its current level, do you feel the hearing in the affected ear is useful to you in any way? For example, can you use that ear on the telephone, or does that ear help you tell where sound is coming from?
- Do you have regular headaches currently or have you had them in the past?