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Y3 - ENT > acoustic neuroma > Flashcards

acoustic neuroma Flashcards

1
Q

What is acoustic neuroma?

A

A non-cancerous tumour on the vestibulocochlear nerve, the main nerve which connects the inner ear and brain.

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2
Q

How common is acoustic neuroma?

A

Very rare

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3
Q

What are the two main symptoms of acoustic neuroma?

A
  1. Hearing Loss
  2. Tinnitus
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4
Q

How does hearing loss commonly occur in acoustic neuroma?

A

Some degree of deafness occurs in most people with an acoustic neuroma. Usually hearing loss is gradual and affects one ear. The type of deafness caused is called sensorineural deafness, meaning that the nerve for hearing is damaged.

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5
Q

What type of hearing loss usually occurs in acoustic neuroma?

A

sensorineural deafness

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6
Q

What is tinnitus?

A

This is the medical name for ringing in the ears
Tinnitus describes any sounds heard within the ear when there is no external sound being made.

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7
Q

How common is tinnitus in one ear for people that have acoustic neuroma?

A

out 7 in 10 people with an acoustic neuroma have tinnitus in one ear.

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8
Q

What other causes of tinnitus are there?

A

Earwax
Ear infections
Ageing
Hearing loss due to other causes

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9
Q

What other symptoms can occur in acoustic neuroma?

A
  1. Vertigo
  2. Loss of feeling (numbness or altered sensation), tingling or pain in the face
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10
Q

What is vertigo?

A

This is a false sensation of movement, commonly spinning.

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11
Q

Why can Loss of feeling (numbness or altered sensation), tingling or pain in the face occur in acoustic neuroma?

A

These symptoms are due to pressure from the acoustic neuroma on other nerves. The nerve that is most commonly affected is called the trigeminal nerve which controls feeling in the face.

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12
Q

How many people with acoustic neuroma experience loss of feeling/pain/tingling in the face?

A

About 1 in 4 people with acoustic neuroma have some facial numbness - this is a more common symptom than weakness of the facial muscles. However, it often goes unnoticed.

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13
Q

What are some differential diagnoses for Loss of feeling (numbness or altered sensation), tingling or pain in the face?

A

similar symptoms can occur with other problems, such as trigeminal neuralgia or a tumour growing on the facial nerve (a facial neuroma).

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14
Q

What are some less common symptoms of Acoustic neuroma?

A
  1. Headache
  2. Earache
  3. Visual problems
  4. Tiredness and lack of energy
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15
Q

When do headaches occur in acoustic neuroma?

A

. It can occur if the tumour is big enough to block the flow of cerebrospinal fluid in the brain.
Obstruction to the flow and drainage of cerebrospinal fluid can cause a problem known as ‘water on the brain’ (hydrocephalus). This results in increased pressure and swelling, and the brain effectively becomes squashed within the skull. This can cause headache and, if untreated, brain damage.

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16
Q

What is the cause of Acoustic neuroma?

A

The cause of most acoustic neuromas is unknown

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17
Q

What is a rare known cause of acoustic neuroma?

A

neurofibromatosis type 2 (NF2).

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18
Q

What is neurofibromatosis type 2 (NF2)?

A

NF2 is a very rare genetic disorder that causes non-cancerous (benign) tumours of the nervous system. People with NF2 can also develop benign tumours on the spinal cord and the coverings of the brain.

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19
Q

How many people does NF2 affect?

A

It affects about 1 in 25,000 people

20
Q

Are acoustic neuromas malignant or benign?

A

Benign

21
Q

Where does the tumour grow?

A

he tumour grows along a nerve in the brain

22
Q

Where did the term ‘acoustic neuroma’ originate from?

A

The term ‘acoustic neuroma’ was used first because the tumour grows on what was previously called the acoustic nerve. However, technically a neuroma is a tumour of nerve cells, whereas these growths originate from the Schwann cells around the nerves.

23
Q

What is the technically correct term for acoustic neuroma?

A

vestibular schwannoma

24
Q

How fast do acoustic neuromas grow?

A

Acoustic neuromas tend to grow very slowly and they don’t spread to distant parts of the body. Sometimes they are too small to cause any problems or symptoms. An acoustic neuroma that is causing no symptoms may occasionally be found incidentally (by chance) on a MRI scan

25
Q

What problems do bigger acoustic neuromas create?

A

Bigger acoustic neuromas can interfere with how the vestibulocochlear nerve works and cause tinnitus or hearing loss most commonly.

26
Q

What is unique about patients with NF2 ?

A

most everyone with NF2 develops an acoustic neuroma on both nerves for hearing (acoustic nerves) - ie there is a tumour on the nerves on both sides of the head (bilateral).

27
Q

Do patients without NF2 with acoustic neuroma have bilateral or unilateral tumours?

A

Unilateral

28
Q

Who is acoustic neuromas most common in?

A

They are more common in middle-aged adults and are rare in children. Acoustic neuromas seem to be more common in women than in men.

29
Q

How easy is it acoustic neuroma to diagnose?

A

Acoustic neuromas can be difficult to diagnose.
Any initial tests will depend on the symptoms caused by the acoustic neuroma. If the tumour causes symptoms such as a headache or balance problems, additional tests may also be necessary to check for other causes of these symptoms.

30
Q

What is the best way to test for acoustic neuroma?

A

The best test to diagnose an acoustic neuroma is a magnetic resonance imaging (MRI) scan of the brain

31
Q

What other testis needed if acoustic neuroma is suspected?

A

Hearing tests are also needed if an acoustic neuroma is suspected. This is because one of the most common symptoms of an acoustic neuroma is hearing loss

32
Q

What other test may be carried out especially if one symptom is unsteadiness?

A

Vestibular (balance) tests

33
Q

What is the treatment for a very small acoustic neuroma?

A

If the acoustic neuroma is very small, doctors might decide that the best way to treat is just to observe and monitor it closely.

34
Q

What are the two main treatments for problematic acoustic neuromas?

A
  1. Surgical removal
  2. Stereotactic radiosurgery
35
Q

What will treatment options depend on for patients?

A

Suitability for surgery or radiotherapy. Factors such as age and general health determine fitness for different treatments.
The growth (tumour). The size and position of the acoustic neuroma will influence the type of treatment offered.

36
Q

Are most people with Acoustic neuroma treated with surgery or stereotactic radiosurgery?

A

Surgery carried out under general surgery.
Although the aim is to remove the tumour completely, sometimes a small part of the tumour is left behind. This is usually because it is technically too difficult to remove the whole tumour and/or there is a risk of causing more damage to the nerve or other nearby structures.

37
Q

What can remains of acoustic neuromas after surgery be treated with?

A

If some of the acoustic neuroma is left remaining, it can often be treated with radiotherapy.

38
Q

How long does recovery typically take?

A

Full recovery typically takes 6-12 weeks, and if the tumour was completely removed, no further treatment is needed usually.

39
Q

What does Stereotactic radiosurgery involve?

A

Stereotactic radiosurgery involves delivering radiation to an extremely well-defined area within the brain - where the acoustic neuroma is.

40
Q

How is stereotactic radiosurgery carried out?

A

Stereotactic means locating a point using three-dimensional (3D) co-ordinates. In this instance, the point is the acoustic neuroma tumour within the brain. A metal frame (like a halo) is attached to the scalp and a series of scans is performed to show the exact position of the tumour. Stereotactic radiosurgery can be given with a normal radiotherapy machine, the CyberKnife® machine, or with a technique known as gamma knife treatment.

41
Q

What is the main advantage of stereotactic radiosurgery?

A

prevent tumour growth and preserve any remaining (residual) hearing. It tends to shrink rather than remove or destroy the acoustic neuroma. It can be used for small tumours.

42
Q

What newer treatments are being trialled but not yet routinely offered in the UK?

A

Proton beam therapy (a form of radiation therapy) and also biological treatments (so called because they interfere with the biological function of the tumour) such as bevacizumab, everolimus, and lapatinib are currently being tried out.

43
Q

What are the possible complications from the treatments for acoustic neuroma?

A
  1. Damage to the facial nerve, causing a facial nerve palsy.
    2.Damage to the vestibulocochlear nerve, leading to deafness (Following surgery for bilateral tumours in those with NF2, there is a strong chance of complete loss of hearing in both ears.)
    3.Damage to the trigeminal nerve, leading to loss of feeling (facial numbness)
44
Q

What are the complications of having an acoustic neuroma?

A
  1. Hearing loss
  2. Hydrocephalus
  3. Damaged caused by pressure on the other nerves in the brain or on the brainstem
45
Q

What is the prognosis for acoustic neuroma?

A

The outlook (prognosis) is generally very good. Acoustic neuromas usually respond well to treatment and complications are uncommon. There is often some permanent hearing loss in the affected ear after treatment but this can be managed successfully with hearing devices.

46
Q

How often is recurring acoustic neuroma?

A

Fewer than 5 in every 100 acoustic neuromas come back. So it is uncommon, but possible.

47
Q

Who is more likely to have reoccurrence of AS?

A

Those affected by NF2

Y3 - ENT (9 decks)

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