Colleen Said:

What causes an acoustic neuroma? What can make it go away other than radiation or surgery? Like medicine?

We Answered:

Mobile phone use and acoustic neuroma risk in Japan

Objectives: The rapid increase of mobile phone use has increased public concern about its possible health effects in Japan, where the mobile phone system is unique in the characteristics of its signal transmission. To examine the relation between mobile phone use and acoustic neuroma, a case-control study was initiated.

Methods: The study followed the common, core protocol of the international collaborative study, INTERPHONE. A prospective case recruitment was done in Japan for 2000–04. One hundred and one acoustic neuroma cases, who were 30–69 years of age and resided in the Tokyo area, and 339 age, sex, and residency matched controls were interviewed using a common computer assisted personal interview system. Education and marital status adjusted odds ratio was calculated with a conditional logistic regression analysis.

Results: Fifty one cases (52.6%) and 192 controls (58.2%) were regular mobile phone users on the reference date, which was set as one year before the diagnosis, and no significant increase of acoustic neuroma risk was observed, with the odds ratio (OR) being 0.73 (95% CI 0.43 to 1.23). No exposure related increase in the risk of acoustic neuroma was observed when the cumulative length of use (<4 years, 4–8 years, >8 years) or cumulative call time (<300 hours, 300–900 hours, >900 hours) was used as an exposure index. The OR was 1.09 (95% CI 0.58 to 2.06) when the reference date was set as five years before the diagnosis. Further, laterality of mobile phone use was not associated with tumours.

Conclusions: These results suggest that there is no significant increase in the risk of acoustic neuroma in association with mobile phone use in Japan.

Go here for treatment options:
http://www.anausa.org/treatment_options.…

Howard Said:

Is Acoustic neuroma fatal? like, can i die from it?

We Answered:

Hi There-

Well, first of all, acoustic neuromas are benign tumors that grow on the vestibular/auditory nerve next to your brain. And, yes, they are certainly one thing that can cause vertigo. There are also a lot of other things that can cause this condition, as you know.

Acoustic neuromas are highly treatable and are only really dangerous when they become so large that they are compressing your brain. In that case, you would have MANY more symptoms, so please don't worry about that.

I had an acoustic neuroma surgically removed 2 years ago; some people can have them treated with very precise radiation (called Gamma Knife or Cyber Knife.) Still other people can just have the tumor monitored and do nothing unless it grows.

If you are concerned that you might have this rare condition, please make an appointment with an ENT who will test your hearing. Acoustic neuroma's almost always cause one sided hearing loss which will be picked up on an audiogram. Share your concerns with your ENT and ask if you should have an MRI to rule out acoustic neuroma. Please note that the MRI MUST be done "with contrast" as that is the best way to see if there is any tumor. An MRI is painless and easy - you just lay very still in a tube while they take pictures of your brain. If you are claustrophic, you may ask your doctor for a prescription for an anti-anxiety drug such as valium or xanax.

Hope this helps. And, please don't worry - this isn't life threatening, just inconvenient.

Donna Said:

is there any possible way could shrink the acoustic neuroma inside my brain with non inasive brain surgery ..?

We Answered:

This website from the University of Pittsburgh has some good insight into the treatment of acoustic neuroma:
http://www.acousticneuroma.neurosurgery.…
Non invasive options such as stereotactic radiosurgery can be successful for small tumors.

Zachary Said:

acoustic neuroma?

We Answered:

This is some information that I found for you. It defines it and includes diagnosis, treatment, and therapy. I hope this helps you.

Acoustic neuroma (or Vestibular Schwannoma) is a benign primary intracranial tumor of the myelin forming cells called "Schwann cells" (Schwannoma) of the 8th cranial nerve --- also known as the acoustic nerve, (or more properly the vestibulocochlear nerve).

The term "acoustic neuroma" is actually a misnomer since the tumor never arises from the acoustic division of the vestibulocochlear nerve (cranial nerve VIII) and the tumor is not a neuroma but a schwannoma.

Approximately 3000 cases are diagnosed each year in the United States with an incidence of about 1 in 100,000. Incidence peaks in the fifth and sixth decades and both sexes are affected equally.

Pathogenesis

Acoustic neuromas may occur sporadically, or in some cases occur as part of von Recklinhausen neurofibromatosis, in which case it may take on one of two forms.

* In Neurofibromatosis type I, a schwannoma may sporadically involve the 8th nerve, usually in adult life, but may involve any other cranial nerve or the spinal root. Bilateral acoustic neuromas are rare in this type.
* In Neurofibromatosis type II, bilateral acoustic neuromas are the hallmark and typically present before the age of 21. These tumors tend to involve the entire extend of the nerve and show a strong autosomal dominant inheritance. Incidence is about 5 to 10%.

The usual tumor in the adult presents as a solitary tumor, originating in the nerve. It usually arises from the vestibular portion of the 8th nerve, just within the internal auditory canal. As the tumor grows, it usually extends into the posterior fossa to occupy the angle between the cerebellum and the pons (cerebellopontine angle). Because of its position, it may also compress the 5th, 7th, and less often, the 9th and 10th cranial nerves. Later, it may compress the pons and lateral medulla, causing obstruction of the CSF and increased intracranial pressure.

Clinical manifestations

Earliest symptoms of acoustic neuromas include unilateral sensorineural hearing loss/deafness, disturbed sense of balance and altered gait, vertigo with associated nausea and vomiting, and pressure in the ear, all of which can be attributed to the disruption of normal vestibulocochlear nerve function. Additionally more than 80% of patients have reported tinnitus (most often a uniteral high-pitched ringing, sometimes a machinery-like roaring or hissing sound, like a steam kettle).

Large tumors that compresses the adjacent brainstem may affect other local cranial nerves. Involvement of the 7th cranial nerve (facial nerve) may lead to facial weakness, sensory impairment, and impairment of glandular secretions; involvement of the 5th cranial nerve (trigeminal nerve) may lead to loss of taste and loss of sensation in the face and mouth. Involvement of the 9th and 10th cranial nerves are uncommon, but may lead to altered gag or swallowing reflexes.

Even larger tumors may lead to increased intracranial pressure, with its associated symptoms such as headache, vomiting, and altered consciousness.

Diagnosis

Contrast-enhanced CT will detect almost all acoustic neuromas > 2.0 cm in diameter and project further than 1.5 cm into the cerebellopontine angle. Those tumors that are smaller may be detected by MRI with gadolinium enhancement. Audiology and vestibular tests should be concurrently evaluated using the Weber's and Rinne's test to assess for sensorineural versus conduction hearing loss.

Treatment

Indicated treatments for acoustic neuroma include surgical removal and radiotherapy.

Conservative treatment

Because these neuromata grow so slowly, a physician may opt for conservative treatment beginning with an observation period. In such a case, the tumor is monitored by annual MRI to monitor growth. Records suggest that about 45% of acoustic neuromata do not grow detectably over the 3-5 years of observation. In rare cases, acoustical neuromata have been known to shrink spontaneously. Often people with acoustic neruromata die of other causes before the neuroma becomes life-threatening. (This is especially true of elderly people possessing a small neuroma.)

Since the growth rate of an acoustic neuroma rarely accelerates, annual observation is essential. Acoustic neuromata may cause either gradual or—less commonly—sudden hearing loss and tinnitus.

Surgery

Removal of acoustic neuromas may be performed using several approaches. Each approach has its advantages and disadvantages. Microsurgery for acoustic neuroma is the only technique that removes the tumor. Radiation treatment (discussed in another section) does not remove the tumor, but has the potential to slow or stop its growth. Surgery is the only treatment that will definitively treat balance symptoms associated with tumor growth, as the vestibular nerves are removed at surgery.

Choice of surgical approach is based on the patient's age, medical condition, size of tumor, and preoperative hearing thresholds and speech discrimination, as well as other tests such as electronystamography, imaging, and auditory brainstem response testing. The patient's and surgeon's preferences also play a significant role.

During removal of the tumor, the tumor along with the superior and inferior vestibular nerves are removed. This results in an acute loss of vestibular input to the brain from the operated side. However, vestibular function improves rapidly due to compensation by the other ear and other balance mechanisms.

Surgery carries risk to the facial nerve which is monitored with facial nerve monitoring during the procedure. Best results (normal or near normal facial function) are more likely with small acoustic neuromas.

Three surgical approaches are commonly used. The first is the translabyrinthine approach, which destroys hearing in the affected ear. Thus, it is often employed in patients who have poor speech discrimination in the affected ear. Any size tumor may be removed with this approach. There is no brain retraction with this approach, and so is often considered the safest route to remove the tumor. In patients with neurofibromatosis type 2 who undergo auditory brainstem implantation, this technique is used as it provides the most direct path of access to the lateral recess and cochlear nucleus, where the device is placed.

The two other approaches (suboccipital/(retrosigmoid) and middle fossa) are hearing preservation approaches, which have a chance of preserving some or all of the hearing in the affected ear. Neurosurgeons often prefer the retrosigmoid approach, as they are frequently more familiar with it from training.

The middle fossa approach is used for tumors typically less than 2cm in greatest dimension, where hearing conservation is to be attempted. This approach has the advantage over the retrosigmoid approach in its direct access to the lateral end of the internal auditory canal. Multiple reports have shown that the retrosigmoid approach cannot reach the lateral end of the internal auditory canal .

Acoustic neuroma surgery is highly technically demanding, and patients are advised to seek out surgical teams with extensive experience.

Radiation Therapy

Radiation therapy is done in a variety of ways, but mainly by two methods: gamma knife radiosurgery or fractionated stereotactic radiotherapy. In the gamma knife approach, 201 beams of gamma radiation are focused on the tumor in a single session. The damage to the tumor at the convergence point may cause it to stop growing but usually does not cause it to shrink in the long term. It may cause short-term shrinkage due to necrosis in the tumor. The damage may be to the tumor cells and/or to the tumor vasculature.

It is not clear what percentage of tumors are controlled by this method for long periods. In earlier times when higher radiation doses were used, the failure rate was about 12% (which then required surgery). Most surgeons feel that these tumors are much more difficult to remove after radiation treatment. Radiation does not remove the tumor, and when irradiated tumors are surgically removed, it is often found that they have growing tumor cells in them.

Two risks of radiation treatment are carcinogenic progression of the acoustic neuroma (conversion from benign to malignant) or induction of other tumors (such as glioblastoma) in the nearby irradiated brain tissue. The incidence of these events appears to be low, and it is often said to be one in one thousand or less. This calculation is done by dividing the number of obvious cases of tumorigenic progression or secondary tumor reported in the medical literature by the estimated number of gamma knife procedures done in the world to date. This is not a scientifically valid method of estimating the carcinogenic risk of medical radiation exposures, and involves a list of very questionable assumptions.

The proper and scientifically valid way to estimate such risks can be found at the web site of the Health Physics Society (http://www.hps.org/), where estimates of the risks of CT scans and other procedures can be found. These calculations have never been made for gamma knife radiosurgery.

Due to the possibility of regrowth and the possibility of tumorigenic progression or secondary tumors, it is essential that radiation treatments for acoustic neuromas be followed by yearly MRI for the rest of the patient's life. MRI at this time (2005) cost about $3,000. Long-term secondary effects (for instance cognitive effects) on a scale of 10-20 years are not yet established for gamma knife surgery.

Fractionated stereotactic therapy involves a beam of ionizing radiation focused on the tumor from a moving gantry. The beam is wider and less accurate than that of the gamma knife. The total dose is also much higher than that used in gamma knife radiosurgery, but the fractionation of the dose (done on many different days) spares normal tissue. This method has not been done on as many patients as gamma knife procedures and there have not been as many years of follow-up study. This means that the tumor control by this method is not yet established, and the incidence of secondary effects of the radiation are not yet known.

:-)

Jessie Said:

Acoustic Neuroma Post Surgery?

We Answered:

I had an AN surgery last year and felt the same symptoms you describe for the first month. Presently, I still have a constant ringing and a plugged up feeling in the affected ear from time to time, but it is nothing major. I have no restrictions and am doing everything I did before the surgery. Looking back on it, it just feels like it was all a big nightmare. Hang in there. I know it's scary and frustrating, but it WILL get better.

Kristen Said:

acoustic neuroma dr for surgery?

We Answered:

Depends on where you live. Typically it will be at a larger university with a neurosurgeon that is very experienced in "skull based surgery" and intracranial tumors. There should be a team approach with an ENT doc to help expose the tumor. Try to find out how many acoustics the doctor does in a year. Someone doing >20/year would be best but these are somewhat rare tumors and that may not be available to you. Its one of those surgeries that it may be best to travel if you have the means but like any surgery, its far more pleasant/convenient/efficient to be close to home so you have to have a substantial difference in the quality of the surgeon to justify travel.

What city are you in?...might have more specific info if you supply that. You do need to act fairly quickly its still a size they may be able to spare your hearing and the facial nerve can usually be fully preserved.

Darryl Said:

has anyone been cured from acoustic neuroma without a surgery ? pls help?

We Answered:

When it comes to something that drastic, always, always get another opinion. I don't think anyone should go into a major surgery like that without a second opinion. It's your right, your Oncologist won't feel bad in fact many doctors welcome a second opinion to confirm their findings. Being a sea captain, I can certainly understand your reluctance, but you have to believe when one sense disappears, another becomes more acute. Also, if you don't have the surgery, is this tumor going to grow, create even greater problems? These are all things you are probably already thinking about. This has to be an individual choice. Sit down with your surgeon, if you haven't already, and talk, talk about what lies ahead with this surgery. Only you can make that choice. Get that second opinion too. God bless and I wish you good health and right choices