Acoustic neuroma: the culprit of hearing loss in some patients

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Acoustic neuroma: the culprit of hearing loss in some patients

Acoustic neuroma: the culprit of hearing loss in some patients. The early symptoms of acoustic neuroma are tinnitus on one side, hearing loss, and dizziness. A small number of patients develop deafness after a longer period of time.

Hearing is one of the “six senses” of human beings, and it is also an important way for people to perceive and understand the world. If hearing is abnormal, it will bring great inconvenience to life. There are many reasons for hearing loss, such as otitis media, tympanic membrane damage, acoustic neuroma, drug toxicity, etc. Among them, acoustic neuroma may be strange to you.

Acoustic neuroma is a tumor originating from Schwann cell of the vestibular nerve sheath of the inner ear canal. It is a benign tumor and one of the common intracranial tumors. It accounts for 6%-8% of intracranial tumors and 80% of cerebellopontine angle tumors. 90%. It mostly occurs in adults, and the peak is 30-60 years old, and there is no significant difference in the prevalence of male and female. It is rare for people under 20 years of age, and single acoustic neuroma in children is very rare. The incidence of acoustic neuroma is similar to the left and right, and bilateral acoustic neuroma is occasionally seen.

What are the symptoms of acoustic neuroma?

As a benign tumor, the main symptoms of acoustic neuroma are caused by compression of nerves and brain tissue.

The early symptoms of acoustic neuroma are tinnitus on one side, hearing loss, and dizziness. A small number of patients develop deafness after a longer period of time. Tinnitus can be accompanied by paroxysmal dizziness or nausea and vomiting. When the tumor continues to grow in the middle stage, it will compress the facial nerve and trigeminal nerve on the same side.

Facial nerve damage is manifested by twitching of the facial muscles and decreased secretion of lacrimal glands, or mild peripheral facial paralysis. Trigeminal nerve damage is manifested as facial numbness, pain, decreased tactile sensation, weakened corneal reflex, weak temporal muscles and masticatory muscles, or muscle atrophy.

Late tumors are too large and will compress the brainstem, cerebellum and posterior cranial nerves, leading to cross hemiplegia and sensory disturbances, cerebellar ataxia, unstable gait, dysphonia, hoarseness, dysphagia, eating Coughing and so on.

Large late stage tumors can also cause obstruction of cerebrospinal fluid circulation, leading to symptoms such as headache, vomiting, vision loss, papilledema, or secondary optic atrophy.

From the evolution of the symptoms of acoustic neuroma, we can find that the early detection of acoustic neuroma is very important. Therefore, when hearing loss becomes more and more serious and the general treatment methods are ineffective, we will begin to doubt whether it is an acoustic neuroma and proceed to the next step of diagnosis and treatment.

How can acoustic neuroma be diagnosed?

A typical acoustic neuroma has the previously mentioned clinical manifestations of progressive aggravation, coupled with imaging and neurological examination can confirm the diagnosis.

Imaging examination can take skull X-ray film, petrous bone plain film suggesting enlargement of the inner ear canal, bone erosion or bone resorption; CT scan can find isodense or low density, a small number of high-density tumors, most of the tumors are round or Irregular shape, located in the mouth area of the inner ear canal, accompanied by dilation of the inner ear canal, the enhancement effect is obvious; MRIT1-weighted image tumor is slightly low or equal signal, T2-weighted image is high signal, fourth ventricle is compressed and deformed, brainstem and cerebellum are also deformed The tumor parenchyma was significantly strengthened after the injection of contrast agent, but the cystic area was not strengthened.

The patient has only tinnitus, deafness and other symptoms in the early stage, and he often sees a doctor in the otology department. Commonly used neuro-otological examinations are hearing examination and vestibular nerve function examination. Hearing examination can distinguish whether the hearing impairment comes from the conduction system, the cochlea or the auditory nerve; the vestibular nerve function examination can reflect the damage of the vestibular nerve of the sick side.

How is acoustic neuroma treated?

The treatment options for acoustic neuroma include follow-up observation, stereotactic radiotherapy and surgical resection.

The main basis for selecting a treatment plan is the size, location, growth rate, whether cystic change of the tumor, as well as the hearing level, the patient’s age, the general condition and the expected value of the treatment effect.

Tumors with a diameter of less than 15mm can be followed up for observation. If its growth rate reaches 2mm/year, it needs active intervention.

Stereotactic radiotherapy includes gamma knife and cyberknife. It has less damage and higher nerve retention rate than surgery, but its tumor recurrence rate is also significantly higher than that of surgery, and the degree of adhesion between tumor and nerve will be obvious after recurrence Increase, re-operation will significantly reduce the nerve function preservation rate.

Surgical treatment is the most important way to treat acoustic neuroma. Generally, patients who have no clear surgical contraindications are recommended to undergo surgical treatment.

Is the surgical treatment of acoustic neuroma minimally invasive?

At present, acoustic neuroma can already undergo endoscopic surgery.

In addition to small incisions, less trauma, quick recovery, and less pain, this surgical program has advantages in protecting the facial nerve and hearing.

(source:internet, reference only)

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