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The most common type of brain tumor is a non-cancerous tumor that grows on a tiny nerve between the inner ear and the brainstem. This happens on the eighth cranial nerve and is made up of several nerves that connect the ear drum to the brain. These nerves are protected by what are called Schwann cells, and with Acoustic Neuroma a tumor begins to grow on these cells. Acoustic neuromas comprise about 6% of all intracranial tumors, about 30% of brainstem tumors, and about 85% of tumors in the region of the cerebellopontine angle -- another 10% are meningiomas. The treatment approach to facial paralysis in this patient population depends on the intraoperative surgical findings.
Because of the origin of acoustics in the vestibular nerve (Source: Komatsuzaki and Tsunoda, 2001), only about twenty percent of the patients will experience vertigo.
Although there may be facial nerve damage these have only occurred where a large tumor is present. If the nerve was cut intraoperatively or if the facial palsy does not resolve, then a more active approach must be taken. Testing such as auditory gadolinium enhanced magnetic resonance imaging, can establish the diagnosis. Middle fossa (through the skull -- hearing preservation is the goal) Each of these approaches has advantages and disadvantages that must be considered in selecting an optimal approach.
Electronystagmography (ENG testing) is frequently abnormal, and about 50% of all tumors are associated with unilateral loss of calorics. Although it is relatively costly compared to audiometry or ABR, the optimal test for excluding an acoustic neuroma is a gadolinium enhanced T1 MRI (Figure 3). If you are suffering from facial paralysis or any other related condition, schedule a consultation with Beverly Hills facial paralysis expert Dr.
A man in his 20's presented to the clinic with a 1 month history of dizziness, imbalance, and a hearing disturbance. On examination (at about 1 month post onset), there was a low amplitude left-beating spontaneous nystagmus. The one week delay in onset of hearing symptoms suggests that there was progression of the disease process in this case over a week. If the tumor continues unchecked, it will sooner or later begin to compress the brainstem and will be life threatening. Acoustic neuroma caused by neurofibromatosis type II (NF 2) should be suspected in young patients and those with a family history of neural tumors.
Only about 10 tumors are newly diagnosed each year per million persons in the United States, corresponding to between 2,000 and 3,000 new cases each year. A conservative approach is prudent if the surgeon who performs the acoustic neuroma feels that the nerve was saved during the operation. Prior to operating this damage may be controlled with carbamazepine medication for neuralgia, at least in some cases. A new technique called a€?Auditory Brainstem Responsea€? testing is less sensitive than enhanced magnetic resonance imaging, but it is considerably less expensive.
Medical management consists of periodic monitoring of the patient's neurological status, use of hearing aids when appropriate, and periodic imaging studies. Even when the tumor is not growing on MRI, there is a risk of losing useful hearing in this situation, making the individual no longer a candidate for hearing preservation type surgery. In most instances, surgical removal of the tumor is the preferred option because it prevents potentially fatal complications of tumor growth.
On MRI, acoustic neuromas are frequently uniformly enhanced, dense, and expand the internal auditory meatus. The unusual aspects are the cochlear enhancement on the MRI, and the one-week delay in onset of hearing symptoms. This is not usual in either labyrinthitis or vestibular neuritis, but might occur due to spread of the infection, or other pathologic mechanisms such as poor circulation to the inner ear. There are two others, left and right, that carry information to the brain which controls a persona€™s balance.
Patients will often require eye care and temporary measures such as suture suspensions to prevent unwanted complications and improve oral issues.
A high-frequency sensorineural pattern is the most common type, occurring in approximately two-thirds of patients.


It has been estimated that 5% of persons with sensorineural hearing loss have acoustics (Source: Daniels et al, 2000). It is felt to be an appropriate method of management in some patients (Source: Hoistad et al, 2001). Somewhere between 10 and 43% of patients followed for about two years lose "useful" hearing (Warrick et al, 1999; Shin et al, 2000). Azizzadeh discusses the nuances of treating an acoustic neuroma while preserving facial nerve function.
A fast spin-echo T2 variant of MRI is very sensitive to acoustics, and in some clinical settings, can be done fairly inexpensively.
There are several other tumors that can occur in the same region of the brain [the cerebellopontine angle (CPA)] as acoustic neuromas. ANA aims to advance acoustic neuroma education and support, as well as increase overall acoustic neuroma awareness.
One week later, hearing deteriorated on the right side, accompanied by tinnitus, a headache and ear pain. While there is a general agreement that MRI is useful to exclude the presence of tumors in persons with unilateral hearing loss, a careful consideration of the cost-benefit ratio in persons with sudden hearing loss (such as is the case in labyrinthitis), to our knowledge, has not been done.
In the remaining third, the next most common observation is hearing loss at low frequency, which is more typical of Meniere's disease.
Conservative approach is prudent if the surgeon who performs the acoustic neuroma feels that the nerve was saved during the operation.
In individuals of advanced age, a serious threat to life or bodily function from tumor growth may be judged unlikely in the remainder of a patient's expected lifespan, and for this reason, medications may be elected. A reasonable estimate is that over a year, about 75% of tumors will have visible enlargement, averaging 1.5 mm, and about 25% will not. Usually the surgery is done at an academic center by a team of surgeons including a neurotologist (a specialized otolaryngologist) and a neurosurgeon. Most are discharged from the hospital within four to six days after surgery, and return to work is usually possible in six weeks. It has been estimated that 5% of persons with sensorineural hearing loss have acoustics (Daniels et al, 2000), but this estimate is suspect as it would imply a much higher prevalence of acoustic neuromas than are commonly accepted.
If an MRI cannot be done, an air-CT scan should be obtained in high-risk individuals, particularly if the ABR is suggestive of an acoustic neuroma. Tumors are staged by a combination of their location and size: An intracanalicular tumor is small and in the internal auditory canal (IAC). OAE's may be present when the hearing loss is being simulated or exaggerated, or when there is an auditory neuropathy causing the hearing loss. In our practice in Chicago Illinois, we commonly do obtain a 3T MRI with contrast in any person with an unexplained substantial, sensorineural hearing loss. Even less commonly, some have the "cookie bite" pattern, which is suggestive of congenital hearing loss. Once a tumor is diagnosed, a repeat scan is obtained at six months and then at yearly intervals (Source: Perry et al, 2001). When abnormal with a progressively worsening pattern, audiometry usually leads to further testing such as ABR (auditory brainstem response) and gadolinium enhanced MRI (magnetic resonance imaging), which establishes the diagnosis. We prefer the higher resolution study (3T) compared to the lower and more usual resolution of 1.5 T, as the cochlea is a very small structure and small changes can be hard to see even on a very good MRI scan. However, because acoustic neuroma is a rare condition, sudden hearing loss attributable to an acoustic tumor occurs in only 1 to 5% of patients with sudden hearing loss as there are many more common causes (Source: Daniels et al, 2000).
A new technique, called summated ABR, which is essentially several ABRs compared over time, may provide better sensitivity. Some tumors cause hydrocephalus by obstructing cerebrospinal fluid (CSF) drainage pathways in the 4th ventricle. Hearing can be completely normal in about 11% of patients (Source: Morrison and Sterkers, 1996). Tinnitus is very common in acoustic neuroma, and is usually unilateral and confined to the affected ear.




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