Vestibular schwannoma: symptoms and treatment

The tumour grows from the Schwann cells that wrap the balance nerve, which runs from the inner ear to the brain through a narrow bony channel. The hearing nerve and facial nerve run through the same channel. As the tumour enlarges, it can press on them.

Cambridge University Hospitals explains that the tumours start inside this channel and grow into the space where the brain sits. They push on the brain once they reach a certain size, but they do not grow into brain tissue. North Bristol NHS Trust stresses that because the tumour is benign, it does not spread to other parts of the brain or body.

The NHS notes a small number of cases result from neurofibromatosis type 2 (NF2). Cambridge says only 5% of vestibular schwannomas occur in people with NF2, which usually arises in teenagers or young adults.

Symptoms develop gradually and may take months or years to appear. The NHS lists hearing loss that usually affects one ear, tinnitus, and vertigo. Cambridge says one-sided hearing loss is usually the most common symptom, and some people also notice imbalance, facial numbness, aching behind the ear, a feeling of fullness in the ear or twitching of the face.

A larger tumour can cause persistent headaches, temporary blurred or double vision, numbness, pain or weakness on one side of the face, co-ordination problems on one side of the body, voice changes or swallowing difficulty (NHS). Some people have no symptoms, and the tumour is found on a scan done for another reason.

• Hearing loss in one ear that develops gradually.

• Ringing or buzzing in the ear (tinnitus).

• Unsteadiness, dizziness or short spells of spinning.

• Facial numbness or, less often, facial weakness.

• Persistent headaches, sickness or vision problems with a very large tumour.

The NHS says acoustic neuromas can be difficult to diagnose because other conditions, such as Ménière's disease, cause similar symptoms. A GP who suspects one refers you to a hospital or clinic for tests such as hearing tests, an MRI scan or a CT scan.

North Bristol NHS Trust says a tumour is sometimes first noticed after an unusual hearing test, and that most are found on MRI. If MRI is not possible, for example because of a pacemaker, CT can be used. Care is planned by a multidisciplinary team that can include brain surgeons, ENT surgeons, radiotherapy doctors, scan specialists and specialist nurses.

The NHS says the choice depends on the size and position of the tumour, how fast it is growing and your general health. All options carry some risks.

The aim of surgery is to remove as much of the tumour as possible while protecting nearby nerves, especially the facial nerve. North Bristol says a thin layer may sometimes be left to protect the nerve and then checked with MRI. The NHS says surgery and radiosurgery can sometimes cause facial numbness or paralysis.

North Bristol also says most people lose hearing in the operated ear and that this usually cannot be fixed. Dizziness, sickness and unsteadiness are common for a while, and physiotherapists can teach balance exercises. Facial weakness can make it hard to close an eye, so eye drops, gels or protection at night may be needed. Serious problems such as infection or leaking brain fluid are described as rare.

The NHS says symptoms such as hearing loss and tinnitus can persist even after treatment and can affect work, communication and driving. North Bristol says hearing loss from a schwannoma is usually permanent and may continue to worsen even if the tumour is not growing.

An audiologist may suggest a hearing aid, a CROS device or a bone-anchored hearing aid. Tinnitus UK offers support for ringing in the ears. For balance, staying active is usually the best way to recover, according to North Bristol.

The NHS says large tumours can be serious because fluid can build up in the brain (hydrocephalus), but this is rare. Many grow very slowly or not at all, and faster-growing ones can be treated before they become too big. After surgical removal, the NHS says a tumour can occasionally return, thought to happen in around 1 in 20 people, so MRI scans usually continue.

North Bristol advises getting same-day help from a GP or emergency department for sudden loss of hearing in one ear within three days or new facial weakness, since steroid medicine may help if given early. Strong headaches, sickness, vision problems, memory trouble or extreme sleepiness need urgent checking.

On the NHS, care is usually led by a skull base or neuro-otology team that brings together ENT, neurosurgery and radiotherapy. Cambridge describes its team as meeting regularly so that you may see more than one specialist at an appointment.

A private ENT or neurosurgical consultation may offer quicker access to MRI and an opinion on options. Because the decision between observation, radiotherapy and surgery is often a balanced one, it is reasonable to ask about the experience of the team, the likely effect on hearing, and what follow-up involves.