Vestibular Schwannoma (Acoustic Neuroma): Symptoms and Treatment

A vestibular schwannoma — commonly called an acoustic neuroma — is a benign (non-cancerous) tumor that grows on the nerve connecting the inner ear to the brain. Although these tumors are not cancer and usually grow slowly, their location near critical structures for hearing, balance, and facial movement means they deserve careful, experienced management.

What is a vestibular schwannoma?

The tumor arises from the Schwann cells that wrap around the vestibulocochlear nerve (the nerve for hearing and balance). As it grows, it can press on nearby nerves and, if large, on the brainstem. Most vestibular schwannomas occur on one side and are not inherited.

Symptoms

Because the tumor affects the hearing and balance nerve, common symptoms include:

• Gradual hearing loss in one ear (the most common first sign)
• Ringing in the ear (tinnitus)
• Dizziness or balance problems
• A feeling of fullness in the ear

Larger tumors can occasionally cause facial numbness or weakness, or headaches. Because one-sided hearing loss and tinnitus have many causes, an accurate diagnosis is important.

How is it diagnosed?

Evaluation typically includes a hearing test (audiogram) and an MRI of the brain, which is very sensitive for detecting even small vestibular schwannomas. The size and location of the tumor, along with your symptoms and hearing, guide the treatment discussion.

Treatment options

There is rarely a single “right” answer — the best choice depends on the tumor’s size and growth, your hearing, your symptoms, your age, and your preferences. The main options are:

• Observation (watchful waiting). Many small tumors grow very slowly or not at all. Monitoring with periodic MRIs is often the safest first step, reserving treatment for tumors that grow or cause problems.
• Stereotactic radiosurgery (such as Gamma Knife). Focused radiation can stop the tumor from growing without an incision, and is a good option for many small-to-medium tumors.
• Microsurgical removal. Surgery removes the tumor and is often recommended for larger tumors or those causing significant symptoms. Modern, minimally invasive and skull base techniques aim to remove the tumor while protecting facial nerve function and, when possible, preserving hearing.

Choosing the right approach

Managing a vestibular schwannoma is a decision best made with a team experienced in these tumors, often including neurosurgery and ear/hearing specialists. The goals are to control the tumor while protecting your hearing, balance, and facial function and maintaining your quality of life.

Dr. Arnaout has subspecialized training in skull base and minimally invasive neurosurgery and works closely with each patient to weigh observation, radiosurgery, and surgery.

When to see a specialist

If you’ve noticed hearing loss or ringing in one ear, or an MRI has identified an acoustic neuroma, an evaluation by a skull base neurosurgeon can help you understand your options and choose the safest path.

To discuss a vestibular schwannoma diagnosis or get a second opinion, request an appointment.