What is an Acoustic Neuroma? (also called vestibular schwannoma)
An acoustic neuroma is a small non-cancerous slow-growing tumour (swelling) on the balance and hearing nerve in the inner ear. The cause is usually unknown and it affects men and women equally, being most commonly diagnosed between the ages of 30 and 60 years.
How is an Acoustic Neuroma diagnosed?
Symptoms first noticed are some one-sided hearing loss and tinnitus (hissing noise in the ear) that may prompt you to see your doctor/GP. Balance may be affected in 50% of people with acoustic neuroma and if the tumour presses on the nerve that supplies the muscles of the face some facial weakness may be experienced.
Your doctor may carry out some simple balance tests in the surgery after hearing about your symptoms and then refer you to an ear, nose and throat ENT specialist at your local hospital for advice and diagnosis.
The ENT hospital doctor will take a careful history of your symptoms and then carry out some tests of your eye and head movements and balance in various positions, in the clinic. He/she will send you for a hearing test and MRI scan of your head and inner ear, involving an injection of dye into a vein in your arm to show up the detailed structures of the inner ear.
If the MRI scan shows an acoustic neuroma, the ENT doctor will give you the diagnosis and refer you to a neurosurgeon at a specialist neurosurgery centre for advice about the best course of treatment/management for you.
The neurosurgeon may repeat some of the tests above and sometimes send you for more detailed balance tests and then discuss your management and treatment options with you.
What Are My Treatment Options for Acoustic Neuroma?
Medical Management Annual Surveillance Monitoring (Watch and Wait)If the tumour is small (less than 1.5cm) the recommendation will be for you to have annual MRI scans to monitor for any changes. If there is no change in size over a few years, the neurosurgeon may extend the interval between scans. If the tumour grows to more than 1.5cm alternative treatments may be discussed by your neurosurgeon with you - see below.
SurgeryAn operation to remove the tumour may be considered, depending on the size and location/position of the tumour and your age and other health conditions. This operation would be carried out at a specialist neurosurgical centre.
Radiotherapy (Gamma Knife Radiosurgery)Radiotherapy to halt the growth of the tumour is an alternative to surgery that is only suitable for smaller tumours. It involves attending a specialist radiosurgery/Gamma Knife centre and having a special frame fitted to your head for an MRI and delivery of the stereotactic (very precise) radiotherapy. Subsequent follow up MRI scans are required, initially along similar lines to ‘Watch and Wait’ above, to check for a satisfactory result and any signs of re-growth.
Your neurosurgeon will discuss these two treatment options with you to decide which would suit you best.
How Can Physiotherapy Help?A specialist Physiotherapist may offer vestibular rehabilitation designed to improve your balance and reduce your dizziness.
If, at any of the stages above, you experience troublesome dizziness and balance problems, you can be referred to a physiotherapist who specialises in balance and dizziness disorders. Your doctor/ENT specialist/neurosurgeon may refer you or you can ask to be referred.
The specialist physiotherapist will assess you by taking a detailed history of your symptoms and how they are impacting on your life, to include your work, hobbies and lifestyle. He/she will test your eye and head movements and balance in various positions. The assessment may include testing of your muscle strength and other factors that may be impacting on your balance and mobility.
A treatment plan will then be drawn up that best meets your needs in terms of addressing troublesome symptoms and working towards achieving your realistic goa, for example returning to work. Physiotherapy treatment will include exercises for you to do at home for example eye and head movements and some that challenge your balance. The exercises will be individually tailored to meet your needs in terms of aiming towards your goal.
The exercises may be difficult, especially initially, as your balance is being challenged in order to improve. Commitment will be required to see any change and you may be asked to do things that you do not like doing and have been avoiding. Persistence is essential and the physiotherapist will support you through this process. This approach is called vestibular rehabilitation. As the name suggests the vestibular system (balance mechanisms) are being rehabilitated, largely through compensation where the unaffected balance mechanisms are being improved to ‘bolster’ those that are failing.
Progress may be slow and the goal that you are aiming for will be broken down into small achievable chunks to work on in stages. Support and understanding from family and friends, and managers/employers will be important. Sometimes physiotherapists will liaise with employers to help them understand the difficulties than can be experienced in the workplace for those with dizziness and how best to manage this. Following a period of absence from work, for example after surgery, phased return to work may be recommended by your doctor.
What Else Can I do to Help Myself? Other things that will support your recovery are:- Keep positive, be patient, accept support from those around you
- Don’t avoid doing things you enjoy that make you feel slightly dizzy
- Get out and about and keep active, for example dancing/ line dancing, gardening, swimming, tai chi and walking are all activities to promote balance and general fitness. You may need to build up gradually to doing some of these activities. Choose something that you enjoy.
- Try something different as it is only by challenging our balance that it improves.
British Acoustic Neuroma Association www.bana-uk.com
The Chartered Society of Physiotherapy (2013) Physiotherapy Works: Vestibular Rehabilitation www.csp.org.uk