Acoustic Neuroma Clinic

The Acoustic Neuroma Clinic team provides treatment of acoustic neuroma, a rare, benign tumor of the balance nerves in the internal auditory canal behind the ear drum, which can only be seen on radiology imaging with CT (computed tomography) or MRI (magnetic resonance imaging) scans.

Acoustic neuroma is typically a very slow growing tumor. Acoustic neuromas grow approximately 1 to 2 millimeters a year. The most common symptom of acoustic neuroma is hearing loss on one side, but it may also cause symptoms of imbalance, vertigo, and problems with facial function. The cause of acoustic neuroma is unknown, but in some cases, there may be a genetic link. Treatment options for acoustic neuroma are observation, surgery, or radiation treatment.

Treatments

Receiving a diagnosis of acoustic neuroma can be very alarming. Acoustic neuromas are slow-growing, benign tumors, and it is quite possible that the tumor has been there for some time before it is discovered. Urgent treatment is rarely needed, so you will have time to think about how you would like to treat your acoustic neuroma.

Almost everyone has three choices for managing your acoustic neuroma:

• Close observation (yearly magnetic resonance imaging (MRI))
• Radiation treatment
• Surgery

You might decide on a different path at a later date. Many patients at first choose to observe with a yearly MRI and later decide to have the tumor treated either because of tumor growth or a change in their hearing loss or other symptoms. In some cases we will recommend additional testing to give you more information on your options.

Let's look at those three basic approaches to managing an acoustic neuroma more closely:

• Observation: On average, acoustic neuromas grow 1 to 2 millimeters per year. However, some tumors grow very slowly (or not at all). Rarely, tumors grow much faster. Because of this slow growth, observation with yearly MRI and hearing test is a reasonable choice for many patients.
• Stereotactic Radiation: This treatment involves radiation beams from multiple sources that are directed at the tumor. This keeps radiation away from tissue that surrounds the acoustic neuroma. In most cases, radiation is given in one dose in a single day. Occasionally, radiation is given over multiple days (“fractionated radiation treatment”).
• Surgery: There are three surgical approaches to acoustic neuroma and all three approaches are performed at Dartmouth Hitchcock Medical Center. We will consider multiple factors to carefully select a surgical approach best suited for your particular case. We will help you prepare and give you a complete outline of expectations. In general, we believe that the goal of surgery should be complete tumor removal.

Surgical approaches

Your tumor size and location, as well as your level of hearing, will determine which surgical approaches will be recommended. The first factor to be considered is whether or not your current hearing can be saved.

The size of the tumor and how much hearing you have already lost help us to tell you whether your hearing may be preserved with surgery. If you have good hearing, it is more likely that your hearing can be saved. If you have already lost a lot of your hearing, then it is less likely that hearing can be saved.

In most cases, surgery cannot restore hearing that is already lost. There are options to help with your hearing if you have already lost the hearing from the tumor or we are unable to preserve your hearing with surgery.

Your first appointment

At your first appointment, you will meet with a doctor and a nurse practitioner of the acoustic neuroma treatment team. We will review the history of your symptoms, complete a neurotology examination, review your hearing test and magnetic resonance imaging (MRI), and discuss your diagnosis and treatment options. We will refer you to other members of our treatment team as needed. At this visit and each visit afterward, you will be asked to complete a brief patient questionnaire.

What you need for your first appointment:

• A CD of your most recent MRI scan. You may also have this sent to us electronically.
• Any prior hearing tests, including the most recent hearing test

If you have films or hearing tests sent to us, please contact us to confirm they are received.

Learn more

Please visit the Acoustic Neuroma Association website to learn more about acoustic neuroma and to find support.