May 13, 2025
Acoustic neuromas are known for their complexity. The tumors, clinically known as vestibular schwannomas, develop on the vestibular nerve. They also grow slowly, meaning their symptoms take years to develop and can be easy to miss. Diagnosing acoustic neuromas is challenging because the symptoms tend to resemble those of middle and inner ear conditions.
Complex conditions such as acoustic neuromas require an integrated team — one that includes experts from across specialties to collaborate on a patient's care.
Diagnosing and treating acoustic neuroma
Often, an acoustic neuroma is discovered incidentally during an MRI ordered by an ear, nose and throat (ENT) specialist. While looking for the cause of a patient's hearing loss, ringing in the ears, dizziness or headaches, the ENT specialist may find a tumor on the sensory nerve that transmits information about hearing and balance from the inner ear to the brain, called the vestibulocochlear nerve.
If an acoustic neuroma is discovered, the healthcare professional typically refers the patient for an evaluation by a neurotologist, an ENT specialist who receives specialized training in the makeup of the inner ear and its connections to the brain.
"Acoustic neuromas are benign tumors that form in very tricky places," says Mallory J. Raymond, M.D., a neurotologist at Mayo Clinic in Jacksonville, Florida. "Because of where they form, they can cause problems that overlap specialty care, including problems with hearing, balance and movement."
The neurotologist performs tests and then discusses possible treatment plans with a team that includes neurosurgeons, radiation oncologists and neuro-oncologists. Because acoustic neuromas are slow growing, if the tumor is small and not causing symptoms, such as headaches or unsteadiness caused by pressure on the brain stem, the team will likely recommend a watch-and-wait approach to treatment. This includes a regular schedule of follow-up imaging scans to ensure the tumor doesn't grow too large or start causing symptoms.
"It's important to go to a team that treats a lot of these types of tumors because they are high risk. If surgery is needed, it's complex."
If the tumor is large or causes symptoms that affect a patient's quality of life, the team will likely recommend surgery. The neurotologist and the neurosurgeon, who work together to remove the tumor, would perform the surgery.
Choosing an acoustic neuroma treatment team
Treating an acoustic neuroma requires a combined team effort, says Kaisorn L. Chaichana, M.D., a neurosurgeon at Mayo Clinic in Jacksonville, Florida.
"It's important to go to a team that treats a lot of these types of tumors because they are high risk," he explains. "If surgery is needed, it's complex, so patients should choose a major academic center that approaches treatment collaboratively."
Dr. Raymond adds: "The management of these kinds of tumors requires input from multiple specialists who bring in slightly different perspectives on managing the downstream and secondary effects, like issues with hearing."
Another factor to consider when choosing a team for acoustic neuroma is finding one that takes the time to listen.
"Developing a good relationship with a healthcare professional is important," says Joseph T. Breen, M.D., a neurotologist at Mayo Clinic in Jacksonville, Florida. "Patients need someone who thinks about what symptoms brought them to the doctor in the first place and what they're trying to solve. And they need a team that takes the time to explain the treatment plan in a way that makes sense and they feel good about."
Because acoustic neuromas are slow growing, Rich W. Byrne, M.D., a neurosurgeon at Mayo Clinic in Jacksonville, Florida, says patients usually have time to research the condition and their choices on where to go for treatment.
"Patients always come in with a long list of questions, and those questions can include, 'How long have you been doing this?' and 'How many of these have you done?'" says Dr. Byrne. "And those are the right questions when looking for a doctor to treat an acoustic neuroma."
Acoustic neuroma treatment at Mayo Clinic in Florida
The acoustic neuroma team at Mayo Clinic in Florida has decades of combined experience treating complex tumors. While the specialists are the busiest in the region, they also see patients quickly.
"If patients call us today with an acoustic neuroma, we'll see them tomorrow," says Dr. Byrne.
For patients who travel to Jacksonville, Florida, from cities or even states far away, appointments with the neurotologist and neurosurgeon are coordinated so they take place on the same day. The team also can follow patients remotely via telehealth whenever possible and work with referring physicians on continuing care.
Dr. Breen adds that while the team sees many acoustic neuromas, the team never treats a patient as a number.
"We're only interested in one, overarching goal," he says. "And that's working together to come up with the best treatment plan for each individual patient. We all follow that one North Star. We're willing to meet people wherever they are on their journey — whether they just learned their diagnosis yesterday, or they've thought about it a lot, or they've already been through treatment."
Plus, neurosurgeons and neurotologists collaborate on patients' care and work hand in hand with radiation oncologists, who use stereotactic radiosurgery to treat small tumors in the brain and spine.
"I refer about a third of the patients I see for radiosurgery because that's the right thing for them," says Dr. Byrne.
Growing expertise for complex brain tumors
The acoustic neuroma team at Mayo Clinic in Florida also continues to grow its capabilities.
While physicians already treat patients using stereotactic radiosurgery procedures such as Gamma Knife and CyberKnife, the hospital system is adding a proton cyclotron, known as a particle accelerator, in 2025. This will allow them to treat tumors with highly precise proton therapy. Compared with other forms of radiation therapy, proton therapy focuses more energy on the tumor itself and less radiation on the surrounding tissue.
Also, in 2027, Mayo Clinic's campus in Florida will become home to the first carbon ion therapy cyclotron in the Western Hemisphere.
Carbon ion therapy is a type of particle therapy like proton and photon therapy that uses focused radiation to kill cancer cells while reducing damage to healthy tissue. Unlike proton and photon therapy, however, carbon ion therapy is more likely to cause a double-strand break in DNA rather than a single-strand break, making it even more effective at destroying tumors, including those that affect the brain.
"That is a differentiator that is going to help us continue to provide the safest, best possible care to patients," says Dr. Byrne.
For more information
Refer a patient to Mayo Clinic.