BEST TREATMENT FOR ACOUSTIC NEUROMA
So you are one of the 100,000 persons diagnosed annually with Acoustic Neuroma (AN) and need to learn what this diagnosis means for you. This diagnosis can be a rollercoaster ride; from the diagnosis to treatment to rehab. I believe in a very patient-centered approach. I try to put myself in your shoes and want to provide information that can lead you to the best possible outcomes. Let’s tackle some of the most relevant topics on your AN journey.
What is an Acoustic Neuroma?
An acoustic neuroma (AKA vestibular schwannoma) is a non-malignant tumor that can interfere with the nerves carrying hearing and balance information from the inner ears to the brain. It’s the third most common tumor in the brain, and normally a slow-growing tumor that develops on the main (vestibular) nerve. Branches of the vestibular nerve directly influence your balance and hearing.
What are the Symptoms?
The most common initial symptom is one-sided hearing loss; 90% of which is progressive
10-12% which is a sudden loss of hearing
Tinnitus or ringing of the ears
Imbalance or progressive clumsiness
Tumors are typically slow-growing so patients feel dizziness more so a feeling of being “off” but less commonly experience vertigo
As a tumor grows in size it may affect one of the cranial nerves, the 7th, known as the facial nerve. People can experience eye twitching, blurred vision, or numbness on one side of the face.
Not everyone will experience these symptoms right away. The brain has a wonderful ability to compensate for the slow-growing tumor and the reduced vestibular input from one inner ear. The slowly declining vestibular input gives the brain lots of time to figure out how to compensate to keep symptoms at a minimum.
It’s only when surgery removes the tumor that the vestibular information coming in has a sudden change, making it harder for the brain to compensate, causing symptoms to appear. If undergoing radiation treatment, the symptoms can appear months afterward as those cells die off and not as drastic as a change as surgery causes.
What Treatment Options Do I have?
Treatment options may vary depending on the size and growth of the acoustic neuroma, your health, and if you’re experiencing symptoms. To treat acoustic neuroma, your doctor may suggest one or more of three potential treatment methods: wait and see, surgery, and radiation therapy.
Wait and See
If you have a small acoustic neuroma that isn’t growing or is growing slowly and causes few or no signs or symptoms, you and your doctor may decide to monitor it, especially if you’re an older adult or otherwise not a good candidate for more aggressive treatment.
Your doctor may recommend that you have regular imaging and hearing tests, usually every six to 12 months, to determine whether the tumor is growing and how quickly. If the scans show the tumor is growing or if the tumor causes progressive symptoms or other difficulties, you may need to undergo treatment.
Vestibular therapy can be helpful in improving balance and assisting the brain with quicker compensation for the declining vestibular input. The therapy will change over time with the changes in the tumor, but none the less can help to improve your symptoms.
Surgery
You may need surgery to remove an acoustic neuroma. Your surgeon may use one of several techniques for removing an acoustic neuroma, depending on the size of your tumor, hearing status, and other factors.
The goal of surgery is to remove the tumor, preserve the facial nerve to prevent facial paralysis, and preserve hearing when possible.
Surgery for an acoustic neuroma is performed under general anesthesia and involves removing the tumor through the inner ear or through a window in your skull.
The entire tumor may not be able to be completely removed in certain cases. For example, if the tumor is too close to important parts of the brain or the facial nerve.
Sometimes, surgical removal of the tumor may worsen symptoms if the hearing, balance, or facial nerves are damaged during the operation.
Complications may include:
Leakage of cerebrospinal fluid through the wound
Hearing loss
Facial weakness
Facial numbness
Ringing in the ear
Balance problems
Persistent headache
Infection of the cerebrospinal fluid (meningitis)
Stroke or brain bleeding
Radiation therapy
Stereotactic radiosurgery. Your doctor may recommend a type of radiation therapy known as stereotactic radiosurgery if you have an acoustic neuroma, particularly if your tumor is small (less than 3 centimeters in diameter), you are an older adult or you cannot tolerate surgery for health reasons.
Stereotactic radiosurgery, such as Gamma Knife radiosurgery, uses many tiny gamma rays to deliver a precisely targeted dose of radiation to a tumor without damaging the surrounding tissue or making an incision. Using imaging scans, your doctor pinpoints the tumor and then plans where to direct the radiation beams.
The goal of stereotactic radiosurgery is to stop the growth of a tumor, preserve the facial nerve’s function and possibly preserve hearing.
It may take weeks, months, or years before the effects of radiosurgery become evident. Your doctor will monitor your progress with follow-up imaging studies and hearing tests.
Complications include:
Hearing loss
Ringing in the ear
Facial weakness
Facial numbness
Balance problems
Treatment failure because of tumor growth
What kind of Doctor Should I see?
Do your research and even a second opinion. Do not be afraid of getting an out-of-state opinion; the treatment can impact the rest of your life! You should be looking for a board-certified head and neck surgeon, neuro-otologist, and neurosurgeon on the team. You can find your local specialists on the Acoustic Neuroma Association health care provider list found here.
What Role Does a Physical Therapist Play in my Recovery?
For those with vestibular symptoms (dizziness, imbalance, disorientation, and motion sickness) vestibular rehabilitation can be a very important part of symptom management and full recovery. Following a thorough assessment by a certified vestibular therapist, they can develop a customized treatment program to help the brain re-establish vestibular information input.
In a study of early treatment post-surgery, researchers found vestibular rehabilitation facilitates recovery of postural control after acoustic neuroma surgery. Customized vestibular rehabilitation should be given in addition to general instructions that stress the need for exposure to movement, AKA “rest is NOT best!”. The study also showed the balance improvements were still present one year later; thus stressing the importance of customized vestibular rehabilitation.
The foundation of vestibular rehabilitation ( a specialized niche in physical therapy) is vestibular adaptation. Adaptation is a series of exercises that drive the naturally occurring reflex produced by the inner ear nerves. The primary goal of the adaptation exercise is to keep your vision stable while you are moving. If you do not have clear vision while you’re walking and moving you will have an imbalance in walking. This imbalance leaves you feeling unsure of yourself and a disorientation-type dizzy feeling in your head. Some other examples of exercises you could expect are:
Keeping balance with eyes closed
Neck stretches to reduce headache or stiffness post-surgery
Watching objects in motion with busy backgrounds
Repeatedly performing a motion that brings on dizziness so that the brain can habituate to it
All exercises are progressed slowly and individualized to your capabilities. A trained vestibular therapist can also address secondary complications that can result from a vestibular disorder, like nausea, concentration issues, fatigue, anxiety, and more.
Vestibular rehabilitation works best when there’s a stable (unchanging) deficit that the brain is trying to compensate for. If the tumor is continuing to grow, vestibular issues can change, making the vestibular rehab process more like trying to catch a moving target.
Once the tumor is gone, vestibular treatments should eventually minimize or eliminate symptoms.
Advanced Visual Surround
Sometimes people can experience a re-occurrence of symptoms long after recovery, known as decompensation. This can be triggered by a stressful physical/emotional event, poor sleep patterns, a new vestibular issue or medical condition, or new medication, etc. It’s important to get re-assessed when this happens and tackle vestibular issues as they appear.
Conclusion
Custom Care Rehab specializes in the treatment of imbalance and dizziness as it pertains to Acoustic Neuroma (AN). After surgery, it could be impossible to get to a therapy gym to complete your 4- 8 weeks of expected therapy. Driving while dizzy is extremely nerve-racking and sometimes just cannot be done. So having the option to receive special treatment in the safety and comfort of your own home is a game-changer! I have helped people reduce their dizziness and improve balance years after their surgery, or even start with pre-surgical education and exercise so you know what to expect and be prepared. Call Custom Care Rehab, 330-618-5703, and we will get through this diagnosis together!
-Amy McMillin, PT, ITPT
Herdman Vestibular Trained 2016
