HEARING & BALANCE DISORDERS:
ACOUSTIC NEUROMA
Introduction



A benign brain tumor
o growth in the brain that usually grows slowly
over many years and does not spread to
other parts of the body.
o This grows on the nerve used for hearing
and balance which can cause hearing loss
and unsteadiness.
Also known as vestibular schwannoma
Damaged cochlear portion of CN VIII → hearing
loss
Symptoms that tend
to develop
gradually
Hearing loss that
usually affects 1 ear
(unilateral hearing loss)
Tinnitus (hearing
sounds that comes
from the inside of the
body like ringing of the
ears)
Vertigo (there is a
sensation that a patient
feels like moving or
spinning)
Large acoustic neuroma
can
sometimes cause:
temporary blurred or
double vision
persistent headaches
numbness, pain or
weakness on 1 side of the
face
problems with limb
coordination/ataxia on 1
side of the body
voice changes or
dysphagia
ASSESSMENT AND DIAGNOSTIC FINDINGS
RISK FACTORS


Age: 30-60 years old
o Average age: 50 y/o
History of the disease neurofibromatosis type
2
o For bilateral neuromas, rare
o Bilateral acoustic neuromas:
- hallmark and typically present before the
age of 21.
o These tumors tend to involve the entire
extent of the nerve and show a strong
autosomal dominant inheritance.
o Incidence is about 5% -10%
Audiovestibular test
o
o
o
Pure tone audiometry: a behavioral test
used to measure hearing sensitivity.
This measure involves the peripheral and
central auditory systems.
Pure-tone thresholds (PTTs) indicate the
softest sound audible to an individual at
least 50% of the time.
CLINICAL MANIFESTATIONS
Head impulse test (HIT)
o
is a useful bedside test to identify peripheral
vestibular deficits
MRI scan
o
To monitor small tumors, and recommend
treatment if scans show tumors getting
bigger.
o
This will be the basis for recommendation of
treatments
CT scan
o
May show erosion and widening of the
internal acoustic canal.
MEDICAL MANAGEMENT


Conservative treatment and routine monitoring
for patients with tumors <1.5 cm
Surgical removal
o Objective: remove the tumor while
preserving facial nerve function.
o Translabyrinthine approach: acoustic
tumors that have damaged the cochlear
portion of the cranial nerve VIII
o Suboccipital of middle cranial fossa
approach: if hearing is still good before
surgery. This procedure exposes the lateral
third of the internal auditory canal and
preserves hearing.
NURSING MANAGEMENT



Protect the ears from loud sounds.
o This can prevent hearing loss from getting
worse.
Try hearing aids if you have trouble hearing or
has a hearing loss exceeding 30DB in the
range of 500 to 2000Hz in the better hearing
ear.
o However, we do not guarantee the patient
that the use of hearing aid can cure the
disease
o This is just use to amplify the sound and
also we have to caution the patient that they
are going to be sensitive of the sound
whenever they wear hearing aids
Think about joining a support group. Share
experiences with other people who have the
same problem may help to cope better