Acoustic Neuroma

Question 1

ESSENCE

Answer 1

Benign tumours of Schwann cells surrounding the auditory nerve

Also called vestibular schwannomas

Question 2

CLINICAL FEATURES

Presentation

Answer 2

• Aged 40-60, gradual onset of
  
  • Unilateral sensorineural hearing loss
  • Unilateral tinnitus
  • Dizziness or imbalance
  • Sensation of fullness in ear
  • Maybe facial nerve palsy

Question 3

Are they unilateral or bilateral usually?

Answer 3

Usually unilateral, bilateral is almost certainly indicative of neurofibromatosis type II

Question 4

INVESTIGATIONS

First line

Answer 4

• Audiometry - assess hearing loss
• Brain imaging (MRI or CT_) - diagnose tumour

Question 5

MANAGEMENT

Options

Answer 5

• Conservative with monitoring (if <1.5cm with no growth)
• Surgery to remove tumour
• Radiotherapy to reduce growth

Question 6

MANAGEMENT

Complications of treatment

Answer 6

• Vestibulocochlear nerve injury with permanent hearing loss or dizziness
• Facial nerve injury with facial weakness