Acoustic Neuroma

Overview

An acoustic neuroma, also called a vestibular schwannoma, is a slow-growing, usually non-cancerous tumor that develops on the nerve that connects the inner ear to the brain. It can affect hearing, balance, and sometimes facial function. It is not a brain tumor in the traditional sense, but it can press on the brain if it grows large.

No, acoustic neuroma is rare. It affects about 1 in every 100,000 people each year, which means it is not a common condition.

It can affect anyone, but it is most often diagnosed in adults between the ages of 30 and 60. It appears slightly more often in women than in men. People with a rare genetic condition called neurofibromatosis type 2 are at higher risk.

Symptoms

Common symptoms

• Hearing loss that gradually worsens on one side
• Tinnitus, which is a ringing or buzzing sound in the affected ear
• Dizziness or balance problems
• A feeling of fullness or pressure in the ear
• Numbness or tingling on one side of the face

Symptoms in children

• Acoustic neuromas are very rare in children. When they do occur, symptoms may include hearing loss on one side, balance problems, headache, or clumsiness. These symptoms may be mistaken for other childhood conditions, so it is important to see a doctor for any persistent ear or balance issue.

Symptoms in older adults

• In older adults, hearing loss and balance issues may be easier to overlook because they can be mistaken for normal aging. Symptoms such as one-sided hearing loss, persistent tinnitus, or unexplained dizziness should always be checked by a doctor.

Causes

Main causes

• The exact cause of an acoustic neuroma is not fully known. It develops from Schwann cells, which form the protective covering around the balance nerve. For most people, there is no clear reason why it happens.
• In a small number of cases, acoustic neuromas are linked to a genetic condition called neurofibromatosis type 2, which causes tumors to grow on nerves.

Risk factors

• A family history of neurofibromatosis type 2
• A personal history of neurofibromatosis type 2
• Very rarely, exposure to high doses of radiation to the head or neck in earlier years

When to see a doctor

See a doctor urgently if:

• If you notice sudden hearing loss in one ear
• If you develop sudden facial weakness or numbness
• If you have severe dizziness that prevents you from standing or walking

Book a routine appointment if:

• If you have gradual hearing loss in one ear that does not go away
• If you have persistent ringing (tinnitus) in one ear
• If you have ongoing balance problems or a feeling of unsteadiness

Diagnosis

Your doctor will begin by asking about your symptoms and examining your ears and nervous system. If your doctor suspects an acoustic neuroma, they will refer you for hearing tests and an imaging scan.

Tests that may be done

• An audiogram, which measures how well you hear different sounds and tones
• An MRI scan (magnetic resonance imaging) of the head with contrast dye, which can clearly show the brain, inner ear, and the acoustic nerve
• Sometimes a CT scan if MRI is not suitable, though MRI is preferred
• A balance test called electronystagmography or videonystagmography in some cases

What to expect at your appointment

The process can take a few weeks. You will not feel anything during the imaging scan, though you may need to stay still for 20 to 30 minutes. You will receive clear instructions about what to do before the test. Once the results are ready, your doctor will explain them and talk with you about next steps. It is normal to feel anxious while waiting, so you can ask your healthcare team for support.

Treatment

Treatment for an acoustic neuroma depends on the size and location of the tumor, how fast it is growing, your age, your general health, and whether the tumor is causing symptoms. The main approaches are careful watching, focused radiation, or surgery. Each option has benefits and risks, and your healthcare team will help you make the best choice for your situation.

Self-care at home

• Use hearing aids if your doctor recommends them, as they can help with one-sided hearing loss.
• Wear a hearing aid in the affected ear if possible, or ask about a CROS hearing device that sends sound from the deaf side to the good ear.
• Take extra care with balance. Use handrails, avoid uneven surfaces, and get up slowly from sitting or lying down.
• Protect the good ear from loud noise and injury, because your remaining hearing is very important.
• Let your family, friends, and colleagues know about your symptoms so they can understand and support you.

Medical treatments

Doctors use three general approaches. First, observation with regular MRI scans is often recommended for small tumors that have not caused severe symptoms. Second, radiation therapy, sometimes called stereotactic radiosurgery, uses tightly focused beams to stop the tumor from growing. This is not surgery; it is a precise type of radiation. Third, surgical removal involves removing the tumor through a procedure performed by a specialist surgeon. Each method has different risks, including the possibility of hearing loss, facial weakness, and balance problems. Your doctor will explain which approach is safest for you.

When is surgery considered?

Surgery may be recommended if the tumor is large, growing quickly, pressing on the brain or facial nerve, or causing severe symptoms. The type of surgery depends on the size and location of the tumor. Your specialist will discuss the benefits and risks in detail.

Living with this condition

Living with an acoustic neuroma means adapting to changes in hearing and balance. With the right support, many people continue to lead full, active lives. You may need to plan extra time for tasks that require balance, such as walking in the dark or on uneven ground. Using railings and good lighting at home can help prevent falls.

Lifestyle tips

• Ask your doctor about vestibular rehabilitation, a specialized type of physiotherapy that helps your brain adjust to balance problems.
• Join a support group for people with acoustic neuroma. Sharing experiences can reduce anxiety and give you practical tips.
• If you have hearing loss, learn about assistive listening devices and ask family members to face you when speaking.
• Reduce stress with relaxation techniques such as deep breathing, meditation, or gentle yoga, but avoid activities that put your balance at risk.
• If you feel unsteady, avoid alcohol and medicines that can cause drowsiness unless your doctor approves them.

Diet and exercise

Eating a balanced, healthy diet and staying active are important for your overall wellbeing. Gentle activities like walking, swimming, tai chi, or cycling can improve balance and strength, but you should check with your doctor first if you have significant balance problems. A physiotherapist can design a safe exercise programme for you.

Mental health and emotional wellbeing

Living with an acoustic neuroma can be stressful. Hearing loss, balance problems, and fear of the tumor may cause anxiety or low mood. These feelings are normal and important to talk about. If you are struggling, speak to your doctor or ask to speak to a counsellor or mental health professional. You can also contact a support group for people with brain or ear conditions. If you are feeling very low or having thoughts of harming yourself, seek help immediately.

Prevention

There is no known way to prevent acoustic neuroma. Because the cause is not clear, there are no reliable lifestyle changes or medications that can stop it from developing or returning. However, if you have a family history of neurofibromatosis type 2, you may be offered genetic counselling to understand your risk and potential screening options.

Vaccines

There are no vaccines to prevent acoustic neuroma. Keeping up to date with other routine vaccines is still important for your general health.

Screening programmes

Routine screening for acoustic neuromas is not recommended for the general public. If you have a genetic syndrome such as neurofibromatosis type 2, your specialist may recommend regular MRI scans to detect tumors early.

Complications

If left untreated

• Without treatment, an acoustic neuroma may continue to grow slowly, leading to progressive hearing loss in the affected ear.
• Large tumors can press on the nerves that control facial movement, causing facial weakness, numbness, or twitching.
• If a tumor becomes very large, it can press on the brainstem or other structures, causing balance problems, difficulty swallowing, or headaches. In rare cases, it can be life-threatening if it affects essential brain functions.

Long-term outlook

The outlook for most people with acoustic neuroma is very good. Because these tumors grow slowly and are not cancer, treatment options are often effective at controlling the tumor. Many people live with a small tumor for years without any serious problems. Hearing loss, if present, can be managed with hearing devices. Your healthcare team will monitor you closely and support you at every step. Thousands of people with acoustic neuroma lead active, fulfilling lives.

Find support

International organisations

• Acoustic Neuroma Association (ANA) ↗

Local organisations

• British Acoustic Neuroma Association (BANA) ↗ · United Kingdom

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