An individual experiencing the symptoms of an acoustic neuroma / vestibular schwannoma) will usually consult a primary care physician first to complain of ringing in the ears, hearing loss, or balance problems. A physician will perform a basic neurological exam, including tests of:
If your doctor finds your symptoms or examination concerning, you will undergo further testing to look for clues to the source of the symptoms. Those tests typically include magnetic resonance imaging (MRI) and computerized tomography (CT) scans, which produce detailed images of the brain and allow doctors to detect the presence of a tumor. Both of these tests are noninvasive, but they do require time in a scanner to produce tiny slices of images that are then combined into three-dimensional pictures. If these tests demonstrate an abnormality, you will need a special contrast agent in advance to help determine what the abnormality represents.
Some tumors are too small to show up on a scan, but a doctor may see an enlarged ear canal or a thickened nerve, both of which are clues that an acoustic neuroma / vestibular schwannoma may be present. If such a tumor is suspected or diagnosed, no matter how small, the patient should be referred to a neurosurgeon with experience in treating these tumors for an evaluation.
Functional Testing
Before a treatment plan can be developed, an individual with an acoustic neuroma / vestibular schwannoma should have a hearing test to determine what damage may have already occurred. The patient will probably also be graded using a test called the House-Brackmann scale, which measures any loss of function in the facial nerves based on the physical exam. Both the hearing and facial nerve tests can help establish the existing levels of functioning, which will help the surgeon make a treatment recommendation.
The goal of treatment is to remove as much of the tumor as possible while preserving the current level of functioning – surgery cannot reverse hearing loss, but some surgical techniques are better able to prevent further loss, depending on the size and shape of the tumor. Some surgical approaches may successfully remove the tumor but result in additional hearing loss, particularly with large tumors. Neurological surgeons choose an approach based on the results of functional tests, the size and location of the tumor, and the condition and preferences of each patient.
More about the Acoustic Neuroma Program
Treatment Options
Monitoring: If the tumor is not growing or posing any threat to surrounding nerves or tissue, or if the patient is older and surgery is a risk, then monitoring may be the best option.
Stereotactic radiosurgery (SRS): Neurosurgeons who specialize in stereotactic radiosurgery may use these highly targeted radiation beams (directed at the tumor from multiple angles) to treat small vestibular schwannomas. (Stereotactic radiosurgery is not usually effective against larger tumors.) Stereotactic radiosurgery has the advantage of being non-invasive and therefore lower risk than open surgery, but it does not produce the immediate results of surgery and may not be suitable for all patients. Find out more about Stereotactic Radiosurgery.
Surgery: Surgical removal of the acoustic neuroma / vestibular schwannoma is usually the best treatment option, particularly for medium and large tumors, with immediate and typically long-term results. See Surgery for Acoustic Neuromas / Vestibular Schwannomas.
Cochlear implant: Some patients may be good candidates for a cochlear implant to address hearing loss if needed after treatment. This is done by our associates in ENT (otolaryngology).
The experts at Weill Cornell Medicine Neurological Surgery have advanced training and expertise in treating acoustic neuromas / vestibular schwannomas, with excellent outcomes. Find out more about the Doctors Who Treat Acoustic Neuromas/Vestibular Schwannomas.
Reviewed by: Philip E. Stieg, PhD, MD
Last reviewed/last updated: October 2023
