What kind of tumor is this
Neuroma grows from Schwann cells that form the sheath of the vestibular portion of the vestibular-cochlear nerve. The tumor is benign, grows very slowly, and in some patients the size remains almost unchanged for years. Problems arise due to the location: in the narrow internal auditory canal, even a small formation compresses the auditory fibers, and when entering the cerebellopontine angle, the tumor can touch the facial and trigeminal nerves, the cerebellum and the brain stem. Bilateral neuromas are characteristic of the hereditary disease neurofibromatosis type 2.
- Benign nerve sheath tumor
- Slow growth, sometimes stunted growth
- Location in the cerebellopontine angle
- Bilateral tumors in neurofibromatosis type 2
- Does not metastasize
Symptoms
Hearing decreases gradually and almost always on one side, speech intelligibility especially suffers: a person hears sound, but poorly understands words, especially on the phone. Often the first thing noticed is a noise or ringing in one ear. Many people note a slight unsteadiness, a swaying sensation that increases in the dark, but severe rotational vertigo is rare because the brain has time to adapt to the slow shutdown of vestibular function. With large tumors, numbness of half the face, weakness of facial muscles, swallowing problems and headache are associated.
- Unilateral hearing loss
- Noise or ringing in one ear
- Poor understanding of speech on the phone
- Unsteadiness and swaying
- Numbness of half the face due to tumor growth
- Weakness of facial muscles
- Headache with large sizes
Diagnostics
The examination begins with an otorhinolaryngologist: hearing is assessed, audiometry is performed, and auditory evoked potential studies are performed, which show the retrocochlear nature of the disorder. The main method of confirmation is magnetic resonance imaging focusing on the area of the inner ear and the cerebellopontine angle, always with contrast: it detects even small tumors. Computed tomography is used less frequently and is mainly used to assess bone structures. For bilateral neuromas, genetic consultation is required.
- Examination by an otolaryngologist
- Audiometry and speech intelligibility assessment
- Auditory evoked potentials
- MRI of the inner ear and brain with contrast
- Facial nerve function assessment
- Genetic consultation for bilateral tumors
Treatment Options
The choice depends on tumor size, age, hearing status and growth rate. For small asymptomatic neuromas in elderly patients, observation with repeated MRI at certain intervals is often chosen: many such tumors hardly grow. Stereotactic radiosurgery stops growth without making an incision and is suitable for small to medium-sized lesions. Microsurgical removal is indicated for large tumors, compression of the brain stem and rapid growth; The surgeon’s main task is to completely remove the tumor, preserving the facial nerve and, if possible, hearing.
- Dynamic observation with control MRI
- Stereotactic radiosurgery
- Microsurgical removal
- Preserving facial nerve function is a priority
- Hearing replacement for hearing loss
- Vestibular rehabilitation
- Observation after treatment
Life after diagnosis
Even with complete hearing loss in one ear, people adapt well, although it becomes more difficult to determine the direction of sound and understand speech in noisy environments. Modern hearing systems, correct positioning at the table and in meetings, and asking your interlocutors to speak from the side of the healthy ear help. Impaired balance is usually compensated, and special exercises speed up this process. During observation, it is important not to skip follow-up MRIs, since the rate of tumor growth may change.
- Regular follow-up MRIs according to schedule
- Vestibular gymnastics
- Hearing aids and systems for one-sided hearing
- Caution when swimming and at heights during the adaptation period
- Observation by an ENT doctor and neurosurgeon
- Psychological support for severe tinnitus