Acoustic Neuroma

Question 1

Pathophysiology of acoustic neuromas

Answer 1

Benign tumours of the Schwann cells surrounding the (vestibulocochlear nerve) that innervates the inner ear

Question 2

Which nervous system are Schwann cells found in

Answer 2

Peripheral nervous system

Question 3

Where do acoustic neuromas occur

Answer 3

At the cerebellopontine angle

Question 4

What is bilateral acoustic neuromas assoiated with

Answer 4

Neurofibromatosis type II

Question 5

Presentation of acoustic neuromas

Answer 5

Typical patient is aged 40-60 years presenting with a gradual onset of:

• Unilateral sensorineural hearing loss (often the first symptom)
• Unilateral tinnitus
• Dizziness or imbalance
• A sensation of fullness in the ear
• Can be associated with a facial nerve palsy

Question 6

In a facial palsy caused by an acoustic neuroma, is the forehead sparred?

Answer 6

No

Question 7

Investigations for an acoustic neuroma

Answer 7

Audiometry - sensorineural hearing loss

CT/MRI head

Question 8

Management of acoustic neuroma

Answer 8

Conservative management - monitoring if asymptomatic
or treatment is inappropriate

Surgery to remove the tumour (partial or total removal)

Radiotherapy to reduce the growth

Question 9

Risks of surgery in acoustic neuroma

Answer 9

Vestibulocochlear nerve injury - permanent hearing loss or dizziness

Facial nerve injury - with facial weakness