ENT - acoustic neuroma

Question 1

What is an acoustic neuroma?

Answer 1

Benign tumour of the Scwann cells surrounding the vestibulocochlear nerve that innervates the inner ear

Aka vestibular schwanomas

Question 2

Where do they occur?

Answer 2

At the cerebellopontine angle

Question 3

Unilateral vs bilateral

Answer 3

Acoustic neuromas - are usually unilateral

Bilateral acoustic neuromas - almost certainly means NF type 2

Question 4

Typical presentation of acoustic neuroma

Answer 4

Usually 40-60 years old with gradual onset of:

• Unilateral sensorineural hearing loss (often the 1st Sx)
• Unilateral tinnitus
• Dizziness or imbalance
• A sensation of fullness within the ear

Can also be associated with a facial nerve palsy if the tumour grows large enough to compress the facial nerve

Question 5

Investigations in suspected acoustic neuroma

Answer 5

Audiometry - will show sensorineural pattern of hearing loss

Rinne’s and Weber’s test

MRI or CT brain (MRI provides more detail than CT)

Question 6

Management of acoustic neuroma

Answer 6

Conservative management with monitoring may be used if there are no symptoms or treatment is inappropriate

Surgery to remove the tumour (partial or total removal)

Radiotherapy to reduce the growth

Question 7

Risks associated with treatment

Answer 7

Vestibulocochlear nerve injury - with permanent hearing loss or dizziness

Facial nerve palsy - facial weakness