Is there a tumor like this inside your ear? (Acoustic Neuroma) Let's learn about it!

Do you sometimes feel like you have reduced hearing in one ear? Or do you just hear a constant ringing in your ear, sometimes feel dizzy, or lose your balance? Although these are things we sometimes don't pay much attention to, there may be a small reason behind this. Today we are going to talk about a tumor that may have such a reason, but is not cancerous, and that is a condition called 'Acoustic Neuroma' .

What is Acoustic Neuroma?

Simply put, acoustic neuroma is a benign tumor. This means that it does not spread to other parts of the body. It is also called a vestibular schwannoma . This tumor develops on a nerve that goes from your inner ear to your brain. To be precise, it develops on the 8th cranial nerve (vestibulocochlear nerve) in our head. This nerve mainly helps you hear (hearing) and maintain your balance (balance).

Think of this nerve as a little cable that carries messages from the ear to the brain. So, when a little tumor forms on this cable, it can interfere with the transmission of those messages. That's how hearing and balance are affected.

Although these tumors do not spread throughout the body like cancer , as they grow, they can affect hearing, cause constant ringing in the ears (tinnitus), lose balance, and sometimes cause numbness or weakness on one side of the face. Treatments for this include surgery and radiation therapy. Chemotherapy is rarely needed.

Is this condition called acoustic neuroma common?

No, it's actually not that common. About one in 100,000 people develop the disease each year. People between the ages of 65 and 74 are more likely to develop the condition than younger people and young children.

What are the symptoms of an acoustic neuroma?

The symptoms of this do not come on suddenly. Most of the time, they appear slowly.

Symptoms that may be seen in the early stages:

• Gradual loss of hearing in one ear: This is the most common early symptom. You may not be able to hear clearly in one ear when talking on the phone, or you may feel that the sound is muffled on one side when someone is talking.
• Tinnitus: This is the constant hearing of various sounds in the ears (e.g., a ringing, buzzing, or humming sound). This can be very bothersome for some people.
• Balance problems: You may feel like you're about to fall while walking, and it may be difficult to stay in one place.
• Vertigo: A feeling of spinning or spinning around you. This can be quite severe.

As the tumor grows, the following symptoms may also occur:

• Facial paralysis or numbness: There may be a tingling sensation on one side of the face, or a feeling of muscle weakness on that side.
• Headaches: Frequent, sometimes severe headaches.
• Nausea and vomiting.
• Taste changes: Food may taste different than usual.
• Difficulty swallowing (Dysphagia).
• Vision problems: Blurred vision or double vision.

Remember, having these symptoms does not mean you have acoustic neuroma. However, if you continue to have one or more of these symptoms, it is important to see a doctor for advice.

Why does this acoustic neuroma occur?

Researchers don't yet know exactly what causes these tumors. But what is known is that they are caused by the abnormal growth of a type of cell called Schwann cells . These Schwann cells are cells that act as a protective sheath around the nerves in our nervous system, especially those involved in hearing and balance.

Another thing is that people with a genetic condition called 'Neurofibromatosis type 2' (NF2) are more likely to develop bilateral acoustic neuromas on the auditory nerves on both sides of the brain.

How do you diagnose this?

When you go to a doctor, he or she will first ask you about your symptoms. Then they will do a physical exam. In addition, they may do tests such as:

• Imaging tests: These can help determine exactly whether a tumor is present, how big it is, and where it is located.
• MRI (Magnetic Resonance Imaging) scan: This is the best way to detect acoustic neuroma.
• CT (Computed Tomography) scan: This is also sometimes used.
• Hearing tests: Various tests are done to see how well you are hearing. One such test is the Auditory Brainstem Response (ABR) .
• Balance tests: There are also tests to check your balance.
• Electronystagmography (ENG): This tests the relationship between eye movements and balance.

What are the treatments for acoustic neuroma?

How this is treated depends on several factors. These include:

• The size of the tumor and its location.
• How much the tumor has affected your hearing and balance.
• Your age and overall health.

There are several main treatment options:

1.Observation:

• Sometimes, if the tumor is very small, if it's growing very slowly, and if you don't have any major symptoms, your doctor may say to do nothing for now and monitor the tumor with regular MRI scans . Many people go for years without any problems.

2. Stereotactic Radiosurgery:

• This is like radiation therapy without surgery. It focuses powerful beams of radiation on the tumor. It can stop the tumor from growing and sometimes shrink it. It causes very little damage to the surrounding healthy tissue. It is usually a one-day treatment.

3. Microsurgery:

• This is the only way to completely remove the tumor. Neurosurgeons perform this surgery very delicately using special instruments. The surgical technique may vary depending on the location and size of the tumor.

• There are several types of microsurgery:
• Middle fossa approach: This method is used if the tumor is located in the ear canal and is relatively small. The tumor is removed through a small incision on the side of the head.
• Retrosigmoid approach: In this, an incision is made behind the ear, and the tumor is removed through a section of the skull and into the inner ear.
• Translabyrinthine approach: This method may be recommended if you have completely lost hearing in one ear. The tumor is removed by making an incision behind the ear and removing the bone of the inner ear. After this procedure, you will not hear in that ear again.

4. Chemotherapy:

• This is rarely used. A drug called bevacizumab can sometimes help shrink tumors, especially to preserve hearing in children with NF2. It is also used to treat radiation necrosis, a complication that can occur after radiation therapy.

5. Vestibular Rehabilitation Therapy:

• Sometimes, during surgery, parts of the nerves involved in balance have to be removed. This can affect the body's balance. Vestibular rehabilitation therapy is a series of exercises and training that retrain the body to compensate for the lost nerve function. This is done by a physiotherapist.

What are the possible complications after microsurgery?

As with any surgery, there are some potential complications that can occur after this surgery. Your medical team will explain these to you in advance. Don't worry, there are treatments and management options for almost all of these.

• Loss or decrease in hearing in one ear.
• Facial paralysis (may be temporary or permanent).
• Tinnitus (ringing in the ears).
• Cerebrospinal fluid (CSF) leak.
• Balance problems.
• Difficulty swallowing.
• Dizziness.
• Double vision or dry eyes.
• Headache.
• Infections.
• Meningitis ( a fever-like condition of the brain - very rare).
• Tumor regrowth (rarely).

If I have an acoustic neuroma, what should I expect?

It depends on many things, such as your condition, the type of treatment you had, and any complications that occurred. Your neurosurgeon will explain the treatment options and possible complications to you.

Sometimes, if you have hearing loss, there are devices that can help. For example, you can use things like 'bone conduction hearing implants' or 'cross hearing aids' (CROS - contralateral routing of signals hearing aids) .

How do I take care of myself?

When you find out you have an acoustic neuroma, you may feel a little scared and worried, especially if your doctor decides to observe you without treatment. You may think things like, "Will this tumor get bigger? Will my hearing get worse?" At that point, ask your doctor what changes indicate that the tumor is affecting the nerves.

If you have symptoms, and your doctor recommends surgery, your balance may be affected after the surgery. If so, your doctor may recommend vestibular rehabilitation therapy, which is mentioned earlier. This can help you get back to normal activities.

What questions should I ask my doctor?

If you have an acoustic neuroma, you may want to ask your doctor questions like these:

• Do I need treatment, or will the tumor be monitored?
• What is the probability that my ear will produce a useful level of hearing?
• What is the chance that this tumor will recur after surgery or radiation treatment?
• Am I at higher risk of developing other types of tumors?
• What are the advantages and disadvantages of acoustic neuroma surgery?
• Will I need rehabilitation treatment after surgery?

Finally, things to remember (Take-Home Message)

Acoustic neuroma is a slow-growing, non- cancerous tumor that can affect your hearing and balance. But don't worry, there are good treatments for it.

Your doctor may recommend surgery to remove the tumor. If so, you may have many questions about the surgery, what will happen after it, whether it will affect your hearing, and other side effects. This is normal. Your medical team is ready to answer all your questions and ease your fears. So, talk to them about everything that is on your mind.

The most important thing is to seek medical advice immediately if you have these symptoms. The sooner the disease is diagnosed, the more successful the treatment can be.

` Acoustic neuroma, ear tumor, vestibular schwannoma, auditory nerve, hearing loss, tinnitus, vertigo