Acoustic neuroma

Question 1

What are the 4 main features of a vestibular schwannoma?

Answer 1

• vertigo,
• hearing loss,
• tinnitus and
• absent corneal reflex

Question 2

What is the acoustic neuroma also known as?

Answer 2

Vestibular schwannoma

Question 3

What is the pathophysiology of acoustic neuroma?

Answer 3

Features predicted by affected cranial nerves:
cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy

Question 4

Which syndrome are bilateral acoustic neuromas associated with?

Answer 4

NF type 2

Question 5

What is the management of acoustic neuromas?

Answer 5

Urgent referral to ENT
Observation - usually initially as slow growing
Surgery
Radiotherapy

Question 6

What is the prognosis with acoustic neuromas?

Answer 6

The tumours are often slow growing, benign and often observed initially.

Question 7

How are acoustic neuromas diagnosed?

Answer 7

MRI of the cerebellopontine angle - investigation of choice.
Audiometry - also important as only 5% of patients will have a normal audiogram.

Question 8

What are the complications of acoustic neuromas?

Answer 8

Post treatment:
* Hearing loss
* Facial weakness/numbness
* CSF leak
* Malignancy/hydrocephalusCNVII palsy after radiation

Question 9

Which cranial nerves are affected in VS?

Answer 9

5, 7, 8 - at the cerebellopontine junction

Question 10

What is the management of acute sensorineural hearing loss in a GP setting?

Answer 10

Urgent referral to ENT

ENT will then do the following;

• MRI to rule out vestibular schwannoma (although most cases are idiopathic)
• High dose corticosteroids