Acoustic Neuroma

Question 1

What is an acoustic neuroma?

Answer 1

Tumours of the vestibulocochlear nerve (CNVIII) arising from the schwann cells of the nerve sheath.
>Typically benign and slow growing but will eventually cause compressive symptoms and become life threatening as they invade further

Question 2

What are risk factors for acoustic neuromas?

Answer 2

• Neurofibromatosis type 2 (bilateral neuromas)

* Ionising radiation

Question 3

What important presentation should be referred for suspected acoustic neuromas always?

Answer 3

• Any unilateral sensorineural hearing loss should be considered as caused by a acoustic neuroma until proven otherwise
• 2 week wait referral needed

Question 4

What is the presentation fo acoustic neuromas?

Answer 4

• Unilateral or asymmetrical hearing loss or tinnitus -progressive or acute onset
• impaired facial sensation
• balance problems without other explanation

Late presentation:

• facial weakness
• brainstem compress and even decreased level of consciousness

Question 5

What is the investigations of choice of acoustic neuromas?

Answer 5

*MRI

Question 6

What is the management of acoustic neuromas?

Answer 6

• Small neuromas and preserved hearing =watch and wait with serial scan (annually)
• Growth detected =surgical