Acoustic neuroma (vestibular schwannoma): symptoms, diagnosis and treatment

The NHS says an acoustic neuroma may not cause any obvious symptoms at first, and that any symptoms tend to develop gradually. The most common are hearing loss that usually only affects 1 ear, hearing sounds that come from inside the body (tinnitus) and the sensation that you are moving or spinning (vertigo).

The Brain Tumour Charity lists hearing loss that gets worse over time, ringing in the ear, a feeling of being off balance or veering to the side when walking, and fatigue as common symptoms. It says larger tumours may cause headache, facial pain and hydrocephalus, a build-up of fluid in the brain that raises pressure inside the skull.

A large acoustic neuroma can also sometimes cause persistent headaches, temporary blurred or double vision, numbness, pain or weakness on 1 side of the face, problems with limb co-ordination (ataxia) on 1 side of the body, and voice changes or difficulty swallowing, according to the NHS.

• Hearing loss, usually in one ear, that gets worse over time.

• Tinnitus: ringing, buzzing or other sounds in the ear.

• Vertigo or feeling off balance and unsteady.

• With larger tumours: headaches, blurred or double vision, facial numbness, pain or weakness, clumsiness on one side, voice changes or difficulty swallowing.

The NHS says to see your GP if you have persistent or troublesome symptoms that you are worried could be caused by an acoustic neuroma. It explains that acoustic neuromas can be difficult to diagnose because the symptoms can be caused by other conditions, such as Ménière's disease.

Other symptoms need quicker action. The NHS hearing loss page says to ask for an urgent GP appointment or get help from NHS 111 if you have sudden hearing loss in 1 or both ears, or your hearing has been getting worse over the last few days or weeks. The NHS tinnitus page says to go to A&E or call 999 if you have tinnitus with sudden hearing loss, weakness in the muscles of your face or a spinning sensation (vertigo), or tinnitus after a head injury.

Sudden face weakness, or weakness or numbness down one side of your body, can be signs of a stroke, which is a medical emergency, and the NHS says to call 999.

The NHS says there are several treatment options depending on the size and position of the tumour, how fast it is growing and your general health. All options carry some risks, and it advises speaking to your specialist about the best option for you and the benefits and risks.

The Brain Tumour Charity says some tumours do not need immediate treatment, usually when they are small and causing mild symptoms, and that you will usually be on active monitoring (also called watch and wait) with regular check-ups or MRI scans. It says neurosurgery is usually used only to remove larger tumours because it can result in loss of hearing in the affected ear as well as incoordination, facial weakness and balance problems.

The Brain Tumour Charity also explains that the surgeon may leave a small part of the tumour to prevent damage to the facial nerve and that any tumour cells left can be treated with stereotactic radiosurgery. It says radiotherapy aims to prevent tumour growth and that stereotactic radiotherapy is the most used.

An acoustic neuroma is a slow-growing tumour that forms near the nerves of the ear. The NHS says it is a type of non-cancerous brain tumour that usually grows slowly over many years and does not spread to other parts of the body. It grows on the nerve used for hearing and balance, which can cause problems such as hearing loss and unsteadiness.

The Brain Tumour Charity explains that the tumour develops from Schwann cells, which wrap the outside of nerves in a coating called myelin, and that a vestibular schwannoma grows from these cells on the vestibular nerve. It says vestibular schwannomas account for 8% of all primary brain tumours and are low grade, which means they are not cancerous.

The NHS says they can sometimes be serious if they become very large, but most are picked up and treated before they reach this stage.

The NHS says acoustic neuromas usually have no obvious cause, although a small number of cases are the result of a genetic condition called neurofibromatosis type 2 (NF2). The Brain Tumour Charity says that nothing you could have done or avoided doing would have caused it, and that more than 90% of vestibular schwannomas occur in people without a family history.

The NHS describes NF2 as a rare genetic condition where non-cancerous tumours grow on nerves in your brain, inner ear and spinal cord, and says that most people with NF2 get tumours in their inner ear, usually appearing in the late teens or early twenties. Genetic testing is sometimes used to diagnose NF2, and a geneticist can explain the chance of any children having it.

The Brain Tumour Charity says that in half of all cases of NF2 the mutation is passed from parent to child.

If your GP thinks you could have an acoustic neuroma, the NHS says you will be referred to a hospital or clinic for tests such as hearing tests to check for hearing problems and whether they are caused by a problem with your nerves, an MRI scan, which gives a detailed picture of the inside of your head, and sometimes a CT scan.

The Brain Tumour Charity says diagnosis can be difficult because the symptoms can be similar to other conditions. For example, hearing loss might be put down to age or earlier exposure to high levels of noise. It lists routine hearing tests, an audiogram to evaluate hearing in both ears, tests of balance, reflexes and strength in the arms and legs, and a scan, usually an MRI, if there is a noticeable loss of hearing in one ear.

Several common conditions share the symptoms of an acoustic neuroma. The NHS information on each condition helps to show the differences, but a clinician has to decide which applies to you.

The NHS says large acoustic neuromas can be serious because they can sometimes cause a life-threatening build-up of fluid in the brain (hydrocephalus), but it is rare for them to reach this stage. Many grow very slowly or not at all, and those that grow more quickly can be treated before they become too big.

Even with treatment, symptoms such as hearing loss and tinnitus can persist and affect your ability to work, communicate and drive, according to the NHS, and these may need additional treatment. It says an acoustic neuroma can occasionally return after treatment, thought to happen to around 1 in every 20 people who have had surgical removal, and that you will probably continue to have regular MRI scans afterwards.

The Brain Tumour Charity says vestibular schwannomas are rarely life-threatening because they are usually slow-growing, and that most people with these tumours can live normal lives for many years with regular checking. It also says targeted therapies such as bevacizumab are being studied in clinical trials.

The usual route is a GP appointment, then referral to an ear, nose and throat or audiology clinic for hearing tests and an MRI scan. The NHS says you will be referred to a hospital or clinic for further tests if your GP thinks you could have an acoustic neuroma.

Treatment decisions are made with specialists, and the NHS says to speak to your specialist about the benefits and risks of each option. Private hearing tests and MRI scans are available too, but a specialist team still needs to decide on monitoring or treatment, so ask how results and follow-up scans will be shared with your GP.