Other reasons for ear problems than Acustic neuroma:

http://www.livestrong.com/article/196106-causes-fullness-ears/


Overview

The ear is a complex network of bones, passageways, cavities and fluid, called endolymph, that work together to allow for hearing and the maintenance of balance. When there are changes in the volume of fluid or pressure in the ear, it can result in a feeling of fullness. A change in fluid volume or an increase in pressure may occur as a result of infections, structural abnormalities or a combination of triggers.

Meniere's Disease

Meniere’s disease is an inner ear disorder characterized by pressure and fullness in the ear and episodes of vertigo, a spinning sensation. Meniere’s disease develops when the volume and composition of fluid in the inner ear changes in some way. Triggers that may cause this fluid change include physical blockage, allergies, viral infections, head trauma and abnormal immune responses, according to the MayoClinic.com. In addition to ear fullness and vertigo, other symptoms of Meniere’s disease include fluctuating hearing loss and tinnitus, which is a perception of abnormal sounds, such as a ringing, buzzing or hissing. There is no cure for Meniere’s disease, but a number of treatments are available. These treatments include diuretics, motion sickness medications and anti-nausea medications. In severe cases, medications may be injected directly into the inner ear or surgery may be used to correct the physical problem inside the ear.

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Eustachian Tube Dysfunction

The eustachian tubes are small canals that connect the throat to the middle ears. The function of the eustachian tubes is to regulate air flow, such as during swallowing, yawning and sneezing. A eustachian tube dysfunction occurs when one of the tubes becomes plugged, which causes a blockage and an abnormal flow of air. Eustachian tube dysfunctions are usually a result of excess mucus and inflammation due to an infection, such as a cold, or allergies, according to the American Academy of Family Physicians. Symptoms of a eustachian tube dysfunction include fullness in the ears, muffled sounds, popping in the ears, pain, tinnitus and difficulty maintaining balance. Most eustachian tube dysfunctions relieve themselves when the infection causing them goes away. If the dysfunction does not correct itself, decongestants and antihistamines may be used to help to reduce inflammation. In chronic cases, a device called an implanting pressure equalization tube, which maintains proper ear pressure, may be inserted.

Otitis Externa

Otitis externa, often referred to as swimmer’s ear, is an infection of the ear canal, the opening that carries sound to the eardrums. The infection usually occurs as a result of excess water in the ears, which breaks down the skin in the canal and makes an easy pathway for bacteria or fungi to enter into the body. Otitis externa may also develop when pus from a middle ear infection drains into the ear canal, according to KidsHealth, an information website sponsored by the Nemours Foundation. Symptoms of otitis externa include ear fullness and pressure, pain, discharge and hearing difficulties. Otitis externa is usually treated with eardrops that contain antibiotics. Oral steroids may also be administered to reduce inflammation. In more severe cases, oral antibiotics will be given and pus will be drained from the ear by a physician.


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http://www.hopkinsmedicine.org/otolaryngology/specialty_areas/otology/acoustic_neuroma_symptoms.html

Acoustic Neuroma: Symptoms


What Are Symptoms of an Acoustic Neuroma (AN)?



Hearing Loss

In over 90% of the patients with AN, the first symptom is a reduction in hearing on one ear due to involvement of the VIII th nerve. The hearing loss may be noticed as a diminished ability to understand spoken words, particularly in difficult listening conditions as with telephone use. Although hearing loss with diminished speech understanding is relatively common in older individuals with both ears affected, the hearing loss and reduced clarity that is more pronounced in one ear should prompt an evaluation by your doctor. With acoustic neuroma, hearing loss is often accompanied by ringing in on ear-- "tinnitus". The hearing loss is usually subtle and worsens very slowly over a period of time. In about 5% of cases, there may be a sudden loss of hearing. Some patients may experience a sense of fullness in the affected ear. Unfortunately, since hearing loss is often mild and there is no pain, there may be a delay in seeking medical attention.
The audiogram is a very sensitive test for hearing. The audiogram measures the "pure tone average," (PTA) the "speech reception threshold" (SRT) and the "speech discrimination" (SD) scores.
  • Pure tone average (PTA) measures the hearing of individual frequencies of sound. The patient is asked to listen to tones of different frequencies (bass up to treble; low up to high pitch). When the patient is first able to hear the tone in the earphone, that signifies the loudness (in "decibels" the unit of loudness) when the sound is heard. This is repeated for each of approximately eight frequencies. The PTA is the "average" of the level in decibels for the tested frequencies. The higher the PTA the worse the hearing.
  • The speech reception threshold (SRT) measures the lowest loudness (in decibels) for detection of speech. Often it is similar in magnitude to the pure tone average. The higher the SRT the worse the hearing.
  • The speech discrimination score (SD) is the percentage of spoken words that can be identified when the words are presented in the earphone (one side at a time). The SD has a "hearing level" above threshold at which the words are read. The lower the SD percentage, the worse the hearing.
The mechanism of hearing loss is compression and/or infiltration of auditory nerve fibers. Pressure applied to the nerve trunk may desynchronize or stagger impulses within individual fibers within the nerve, thereby disrupting the clarity of sound. Impairment of the blood supply to the nerve or inner ear may also play a role. In the majority of patients, hearing loss progresses gradually over many years, eventually leading to total deafness in the ear on the side of the tumor. The loss is usually unilateral, or asymmetric, and mainly involves the higher frequencies of sound. Characteristically, speech discrimination is affected more than the pure tone hearing loss (pure tone average).
Less than 2% of patients presenting with sudden hearing loss will ultimately prove to have an AN. Other forms of hearing loss are relatively frequent. In a study of a large group of AN patients, only two-thirds had a high frequency biased hearing loss and approximately 20% had loss at the lower frequencies of sound. A sudden decrease in hearing, often associated with viral infection or vascular occlusion, occurs in about one in eight AN patients. Presumably, sudden hearing loss results from tumor compression. In some patients it may be triggered by head trauma or vigorous physical exercise. The loss may be partial or total, and spontaneous recovery is possible. Sudden loss may be the first event that leads to a diagnosis, or may occur months or years prior to the tumor's discovery.
A small proportion of AN patients have either normal hearing or symmetric hearing loss. In a recent series, 15 % of AN patients had subjectively normal hearing, of whom only 4 % had normal audiograms SRT (speech reception threshold) < 25 dB, SDS (speech discrimination score) >85 %). In addition, 7% of patients had audiometrically symmetrical hearing.


Tinnitus (Ringing in the ears)

Definition: Tinnitus (pronounced tin’-it-is) is the perception of ringing, hissing, or other sound in the ears or head when no external sound is present. Tinnitus can be intermittent or constant—with single or multiple tones—and its perceived volume can range from subtle to overwhelming. In the United States, an estimated 12 million people have tinnitus.
Tinnitus is very frequent in AN as it is many inner ear diseases. In most cases, the tinnitus is high pitched and localized to the tumor ear. However, the symptom may be non-localizing and may be of unusual pitches. A few patients with AN present with unilateral tinnitus in the absence of subjective hearing loss. Thus, unilateral tinnitus occurring without explanation is an indication for an evaluation for AN.


Vertigo

Vestibular nerve: Since the tumor usually arises from the vestibular nerve which is responsible for balance, unsteadiness or balance problems may be one of the earlier symptoms in the growth of the tumor. Since the remainder of the balance system compensates for this loss, balance problems may stabilize.
Redundancy: There is bilateral innervation of the brainstem by each vestibular nerve. This means that the left vestibular nerve innervates the left and right brainstem, and the right vestibular nerve does the same. This "redundancy" means that it is very difficult for a tumor to completely remove all balance. Similarly, if one of the vestibular nerves is resected as a tumor is removed, the other side appears able to restore a level of activity that enables the restoration of balance.
True vertigo is not commonly associated with AN. In a recent series, only one in five of patients had vertigo, most of whom had small tumors. Vertigo is very infrequent with larger tumors at the time of diagnosis. Thus, it appears that vertigo is caused early in AN growth, perhaps by destruction of the vestibular nerve or through interruption of the blood supply to the labyrinth. With growth, the central nervous system appears capable of adapting the loss of balance information from the affected ear, and thus the sense of vertigo subsides.


Imbalance

Dysequilibrium is much more prevalent than vertigo. Dysequilibrium occurs in nearly half of AN patients. In contrast to vertigo, which decreases in incidence with increasing tumor size, dysequilbrium becomes more frequent with larger tumor sizes. The most likely mechanisms involved in causing dysequilibrium are uncompensated unilateral vestibular deafferentation or persistent perverse input from the diseased vestibular nerve.
Cerebellar dysfunction is intention tremor and gait ataxia (unsteady walking). Large ANs indent the lateral cerebellar lobe and peduncles and may compress part of the cerebellum. Outright cerebellar dysfunction is uncommon in AN, and is limited to large tumors. Although little information is available on its exact incidence, truncal (trunk, abdomen, chest) ataxia appears to be more common than limb ataxia. Patients tend to fall towards the side of the tumor.


Pressure

As the AN grows, the capsule of the tumor presses upon the lining of the inside of the skull (the dura). The dura has sensory fibers that can transmit the sensation of the pressure. The headache that results from the acoustic neuroma can be dull or aching in quality and is usually unilateral. The headache may "radiate" to the neck, top of the head or front of the head.


Facial Weakness & Numbness

Muscle innervation: For the acoustic neuromas, pressure upon or infiltration of the tumor into the facial nerve may result in facial weakness. The muscles supplied by the facial nerve include the muscles of facial expression and spontaneous emotion. The muscles for eye closure, raising the eyebrows and wrinkling the forehead are innervated by the facial nerve. Facial weakness is rare at the time of diagnosis, though spasms of the facial nerve caused by tumor compression are not uncommon.
Tears and taste: The facial nerve also has functions of "tear" formation and taste. Pressure on the nerve can cause dry eye or even unexpected "tear" formation. The branch of the facial nerve that controls tearing is the greater superficial petrosal nerve. The branch of the facial nerve that provides the sense of taste to the anterior two-thirds of the tongue is the "chorda tympani."
Facial numbness: As the tumor grows larger in size and starts pressing on other nerves, mainly the trigeminal nerve, facial sensation may be affected. The patients will then experience numbness and facial tingling, constantly or intermittently. There may be facial tingling on the side of the AN.
The tingling or "paresthesia" may be near the corner of the mouth or on the cheek. Facial numbness is not as common as the facial weakness. Patients may also have facial tics or spasms. As the tumor grows larger or presses on the brainstem, the patient will experience headaches, facial weakness, vertigo and unsteady gait due to raised intracranial pressure.

___


http://www.patient.co.uk/health/acoustic-neuroma-leaflet

An acoustic neuroma (also called a vestibular schwannoma) is a rare growth (tumour) in the brain. It often grows in size but does not spread to other parts of the body. This means it is benign.
The tumour grows on a nerve in the brain near to the ear. It can cause problems with hearing and balance, and also ringing in the ears (tinnitus). In most cases, the cause is unknown. However, some acoustic neuromas are associated with the disease neurofibromatosis type 2.
Acoustic neuromas are usually slow-growing and are rarely life-threatening. Treatment is most often with surgery, but radiotherapy can also be used. Some permanent deafness in one ear is common after treatment for an acoustic neuroma.


What is an acoustic neuroma?

An acoustic neuroma is a rare type of brain tumour (growth). It is not cancerous and so is called a benign tumour. The tumour grows along a nerve in the brain (a cranial nerve) that is called the acoustic or vestibulocochlear nerve. This nerve controls your sense of hearing and balance.
Acoustic neuromas grow from a type of cell called a Schwann cell. These cells cover nerve cells. This is why the tumour is also called a vestibular schwannoma. Acoustic neuromas tend to grow very slowly and they don't spread to distant parts of the body. Sometimes they are too small to cause any problems or symptoms. Bigger acoustic neuromas can interfere with the vestibulocochlear nerve.


What is the cause of acoustic neuromas?

The cause of most acoustic neuromas is unknown. About 7 out of every 100 acoustic neuromas are caused by neurofibromatosis type 2 (NF2). NF2 is a very rare genetic disorder that causes benign tumours of the nervous system. It affects about 1 in 350,000 people. Almost everyone with NF2 develops an acoustic neuroma on both nerves for hearing (acoustic nerves) - ie bilateral tumours. People with NF2 can also develop benign tumours on the spinal cord and the coverings of the brain.

How common are acoustic neuromas?

Acoustic neuromas are rare. About 13 people in every million are diagnosed each year with an acoustic neuroma in the UK. Brain tumours themselves are rare. Brain tumours can be non-cancerous (benign) or cancerous (malignant). Brain tumours are divided into two main groups:
  • Primary brain tumours originate in the brain. An acoustic neuroma is a primary brain tumour.
  • Secondary brain tumours are tumours in the brain that have spread from other parts of the body. They are often referred to as secondaries or brain metastases. These are malignant tumours.
Acoustic neuromas account for about 8 in 100 primary brain tumours. They are more common in middle-aged adults and rare in children. Acoustic neuromas seem to be more common in women than in men.

What are the symptoms of an acoustic neuroma?

A small acoustic neuroma may cause no symptoms. If you do have symptoms from an acoustic neuroma, these usually develop very gradually, as the tumour is slow-growing. The symptoms that an acoustic neuroma can cause are very common. Remember that acoustic neuromas are very rare. You should see your doctor if you have any of these symptoms, but they are more likely to be due to other conditions than a brain tumour.
The most common symptoms of an acoustic neuroma are:

  • Hearing loss. Some degree of deafness occurs in most people with an acoustic neuroma. Usually hearing loss is gradual and affects one ear. The type of deafness caused is called sensorineural deafness and means the nerve for hearing (the acoustic nerve) is damaged.
  • Tinnitus. This is the medical name for ringing in the ears. About 7 in 10 people with an acoustic neuroma have tinnitus in one ear. The sounds can vary; it does not have to be ringing like a bell. Tinnitus describes any sounds heard within the ear when there is no external sound being made. Tinnitus is a common symptom and not a disease in itself. Other causes of tinnitus include earwax, ear infections, ageing and noise-induced hearing loss.
Other, common symptoms of acoustic neuroma include:
  • Vertigo. This is the sensation of the room spinning, often described as dizziness. It is not a fear of heights as some people incorrectly think. This feeling of movement occurs even when you are standing still. Vertigo can be caused by other conditions affecting the inner ear. Nearly half of people with an acoustic neuroma have this symptom, but less than 1 in 10 have it as their first symptom.
  • Loss of feeling (facial numbness), tingling or pain. These symptoms are due to pressure from the acoustic neuroma on other nerves. The commonly affected nerve is called the trigeminal nerve which controls feeling in the face. About 1 in 4 people with acoustic neuroma have some facial numbness - this is a more common symptom than weakness of the facial muscles. However, it is often an unnoticed symptom. Similar symptoms can occur with other problems, such as trigeminal neuralgia or a tumour growing on the facial nerve (a facial neuroma).
Less common symptoms of acoustic neuroma are:
  • Headache. This is a relatively rare symptom of an acoustic neuroma. It can occur if the tumour is big enough to block the flow of cerebrospinal fluid in the brain. Cerebrospinal fluid is the clear, nourishing fluid that flows around the brain and spinal cord, protecting the delicate structures from physical and chemical harm. Obstruction to the flow and drainage of cerebrospinal fluid can cause a problem known as 'water on the brain' (hydrocephalus). This results in increased pressure and swelling, and the brain effectively becomes squashed within the skull. This can cause headache and, if untreated, brain damage.
  • Earache. This is another rare symptom of acoustic neuroma. There are many more common causes of earache.
  • Visual problems. Again, these are a rare symptom. If they do happen, it is due to hydrocephalus (see above).
  • Tiredness and lack of energy. These are nonspecific symptoms and can be due to many causes. It is possible that a non-cancerous (benign) brain tumour could lead to this.

What tests are needed to diagnose an acoustic neuroma?

Acoustic neuromas can be difficult to diagnose. If your GP suspects that you have an acoustic neuroma from your symptoms, you would probably be referred to a hospital ear, nose and throat (ENT) surgeon.
The best test to diagnose an acoustic neuroma is a magnetic resonance imaging (MRI) scan of the brain. An MRI scan uses a strong magnetic field and radio waves to take a detailed picture of your brain, and of the structures inside it. It is painless but it can be noisy and can make you feel anxious about being 'closed in' (claustrophobic). No X-rays are used (so it is different to a CT scan which does use X-rays). See also the separate leaflet called MRI Scan for more information.
**Hearing tests** may also be performed if an acoustic neuroma is suspected. This is because one of the most common symptoms of an acoustic neuroma is hearing loss. If an acoustic neuroma is found on a scan, it is useful to know what your hearing in both ears is like before treatment.

What is the treatment for acoustic neuroma?

If you have a very small acoustic neuroma, your doctors might decide that the best way to treat you is just to observe and monitor it closely. This is because acoustic neuromas are very slow-growing and may not cause any symptoms for a long time. Remember, acoustic neuromas are not malignant and do not spread, so it is quite safe to watch things for a while. Also, treatments can have complications and side-effects. Therefore, the risks and benefits of treatment have to be balanced. If observation is recommended, your condition will be monitored with regular scans.
The main treatments for acoustic neuroma are surgery or stereotactic radiosurgery. The treatment you are offered will depend on:

  • Your suitability for surgery or radiotherapy. Factors such as age and general health govern how fit you are for different treatments.
  • Your tumour. The size and position of your acoustic neuroma will influence the type of treatment offered.
The results of the tests and scans you have can also help to determine which type of treatment is best for you and your tumour.

Surgery

Either a brain surgeon (neurosurgeon) or an ENT surgeon can operate to remove an acoustic neuroma, depending on its size and location on the vestibulocochlear nerve in the brain. The surgery is carried out under a general anaesthetic.
Most people with acoustic neuroma are treated with surgery, and about 95 in 100 tumours can be removed completely. Occasionally (about 5 cases in every 100), a small part of the tumour is left behind. This is usually because it is technically too difficult to remove the whole tumour and/or there is a risk of causing more damage to the nerve or other nearby structures.
If some of the acoustic neuroma is left remaining, it can often be treated with radiotherapy. After surgery for an acoustic neuroma, you will probably have to remain in hospital for a few days for monitoring. You should be fully recovered within 6-12 weeks, and, if your tumour was completely removed, you should not need any more treatment.


Stereotactic radiosurgery

This is a newer type of treatment that can be used for acoustic neuromas. Stereotactic radiosurgery involves delivering a very precise single dose (usually) of radiation to an extremely well-defined area within the brain - where your acoustic neuroma is.
Stereotactic means locating a point using three-dimensional (3D) co-ordinates. In this instance, the point is the acoustic neuroma tumour within the brain. A metal frame (like a halo) is attached to your scalp and a series of scans is performed to show the exact location of the tumour. Stereotactic radiosurgery can be given with a normal radiotherapy machine, the CyberKnife® machine or with a technique known as gamma knife treatment.
Stereotactic radiosurgery is a very specialised type of treatment and is only available in some large hospitals. These hospitals are usually ones with both neurosurgery and cancer treatment (oncology) centres. The main advantage of this treatment is to prevent tumour growth and preserve any remaining (residual) hearing. It tends to shrink rather than remove or destroy the acoustic neuroma. It can be used for very small tumours.

Are any complications likely from an acoustic neuroma?

Complications can be thought of as:
  • Due to the tumour itself.
  • Due to treatments for acoustic neuroma.
  • Return (recurrence) of an acoustic neuroma.

Possible complications due to the acoustic neuroma

  • Hearing loss. The most common symptom of an acoustic neuroma is hearing loss. This is due to damage to the vestibulocochlear nerve that the acoustic neuroma is growing on. Even if the acoustic neuroma is removed with surgery, or destroyed with radiotherapy, a degree of permanent hearing loss in one ear is usual. The extent to which you will be affected by hearing loss varies from person to person. It can depend on things such as how big the tumour is, how much damage has been caused and how difficult treatment was. It is possible to be left with severe or even complete deafness on the side of the acoustic neuroma.
  • 'Water on the brain' (hydrocephalus). If your acoustic neuroma grows very large, a complication called hydrocephalus can occur. This happens because the flow of cerebrospinal fluid is obstructed (see above, under 'Less common symptoms of acoustic neuroma'). Pressure can build up inside the brain, leading to permanent brain damage if not identified and treated. The condition can be treated by inserting a drainage tube (called a shunt) to relieve the pressure and allow the cerebrospinal fluid to flow. Hydrocephalus is very unlikely if you have treatment for an acoustic neuroma.
  • Damage caused by pressure on other nerves in the brain, or on the brainstem. If the acoustic neuroma is growing and untreated, it can cause problems by pressing on nearby structures in the brain. This can lead to some of the symptoms of acoustic neuroma, listed earlier. Long-term pressure can cause permanent damage. It is possible that the trigeminal nerve (which controls feeling in the face) or the facial nerve (which controls movements of the muscles of the face) can be affected. The brainstem is the lower part of your brain that connects to the spinal cord. It controls vital bodily functions. If the brainstem is affected (very rare) then it is possible to have problems with breathing, consciousness, the circulation, co-ordination and balance, and your arm and leg function. Again, if you have treatment for your acoustic neuroma before it has had the chance to grow very big (remember, it is a slow-growing tumour), this sort of complication is very unlikely.

Possible complications due to treatments for acoustic neuroma:

  • Damage to the facial nerve, causing a facial nerve palsy. The facial nerve is the nerve in the brain that controls movements in the muscles of the face. If an acoustic neuroma has grown quite large, removal during surgery can potentially lead to damage of this neighbouring nerve. If the nerve is damaged, there will be paralysis of part of the face. This can cause a problem with drooping of one side of the face. In some cases, physiotherapy will help but, in others, the damage is permanent. Obviously, during surgery, great care is taken to identify and avoid damage to surrounding nerves.
  • Damage to the vestibulocochlear nerve, leading to deafness. As mentioned, a degree of hearing loss is normal after treatment for acoustic neuroma. If you have NF2 and bilateral tumours, there is a strong chance that after surgery, you will completely lose the hearing in both of your ears.
  • Damage to the trigeminal nerve, leading to loss of feeling (facial numbness). In the same way that the facial nerve can be damaged during surgery to remove an acoustic neuroma, the trigeminal nerve can also be injured. If this occurs, there is loss of sensation to parts of the face.

Return (recurrence) of acoustic neuroma

Fewer than 5 in every 100 acoustic neuromas come back. So it is uncommon, but possible. It is more likely if you have NF2. It could cause any of the symptoms mentioned earlier, or any of the complications. After treatment for acoustic neuroma you will generally be followed up in an outpatient clinic to check for any symptoms or signs of a recurrence.

What is the outlook (prognosis) with an acoustic neuroma?

The outlook is generally very good, particularly as it is a non-cancerous (benign) tumour. It is generally very suitable for treatment and complications are uncommon. There is usually a degree of hearing loss in the affected ear after treatment.
___



An acoustic neuroma (also called a vestibular schwannoma) is a rare growth (tumour) in the brain. It often grows in size but does not spread to other parts of the body. This means it is benign.
The tumour grows on a nerve in the brain near to the ear. It can cause problems with hearing and balance, and also ringing in the ears (tinnitus). In most cases, the cause is unknown. However, some acoustic neuromas are associated with the disease neurofibromatosis type 2.
Acoustic neuromas are usually slow-growing and are rarely life-threatening. Treatment is most often with surgery, but radiotherapy can also be used. Some permanent deafness in one ear is common after treatment for an acoustic neuroma.


What is an acoustic neuroma?

An acoustic neuroma is a rare type of brain tumour (growth). It is not cancerous and so is called a benign tumour. The tumour grows along a nerve in the brain (a cranial nerve) that is called the acoustic or vestibulocochlear nerve. This nerve controls your sense of hearing and balance.
Acoustic neuromas grow from a type of cell called a Schwann cell. These cells cover nerve cells. This is why the tumour is also called a vestibular schwannoma. Acoustic neuromas tend to grow very slowly and they don't spread to distant parts of the body. Sometimes they are too small to cause any problems or symptoms. Bigger acoustic neuromas can interfere with the vestibulocochlear nerve.


What is the cause of acoustic neuromas?

The cause of most acoustic neuromas is unknown. About 7 out of every 100 acoustic neuromas are caused by neurofibromatosis type 2 (NF2). NF2 is a very rare genetic disorder that causes benign tumours of the nervous system. It affects about 1 in 350,000 people. Almost everyone with NF2 develops an acoustic neuroma on both nerves for hearing (acoustic nerves) - ie bilateral tumours. People with NF2 can also develop benign tumours on the spinal cord and the coverings of the brain.

How common are acoustic neuromas?

Acoustic neuromas are rare. About 13 people in every million are diagnosed each year with an acoustic neuroma in the UK. Brain tumours themselves are rare. Brain tumours can be non-cancerous (benign) or cancerous (malignant). Brain tumours are divided into two main groups:
  • Primary brain tumours originate in the brain. An acoustic neuroma is a primary brain tumour.
  • Secondary brain tumours are tumours in the brain that have spread from other parts of the body. They are often referred to as secondaries or brain metastases. These are malignant tumours.
Acoustic neuromas account for about 8 in 100 primary brain tumours. They are more common in middle-aged adults and rare in children. Acoustic neuromas seem to be more common in women than in men.

What are the symptoms of an acoustic neuroma?

A small acoustic neuroma may cause no symptoms. If you do have symptoms from an acoustic neuroma, these usually develop very gradually, as the tumour is slow-growing. The symptoms that an acoustic neuroma can cause are very common. Remember that acoustic neuromas are very rare. You should see your doctor if you have any of these symptoms, but they are more likely to be due to other conditions than a brain tumour.
The most common symptoms of an acoustic neuroma are:

  • Hearing loss. Some degree of deafness occurs in most people with an acoustic neuroma. Usually hearing loss is gradual and affects one ear. The type of deafness caused is called sensorineural deafness and means the nerve for hearing (the acoustic nerve) is damaged.
  • Tinnitus. This is the medical name for ringing in the ears. About 7 in 10 people with an acoustic neuroma have tinnitus in one ear. The sounds can vary; it does not have to be ringing like a bell. Tinnitus describes any sounds heard within the ear when there is no external sound being made. Tinnitus is a common symptom and not a disease in itself. Other causes of tinnitus include earwax, ear infections, ageing and noise-induced hearing loss.
Other, common symptoms of acoustic neuroma include:
  • Vertigo. This is the sensation of the room spinning, often described as dizziness. It is not a fear of heights as some people incorrectly think. This feeling of movement occurs even when you are standing still. Vertigo can be caused by other conditions affecting the inner ear. Nearly half of people with an acoustic neuroma have this symptom, but less than 1 in 10 have it as their first symptom.
  • Loss of feeling (facial numbness), tingling or pain. These symptoms are due to pressure from the acoustic neuroma on other nerves. The commonly affected nerve is called the trigeminal nerve which controls feeling in the face. About 1 in 4 people with acoustic neuroma have some facial numbness - this is a more common symptom than weakness of the facial muscles. However, it is often an unnoticed symptom. Similar symptoms can occur with other problems, such as trigeminal neuralgia or a tumour growing on the facial nerve (a facial neuroma).
Less common symptoms of acoustic neuroma are:
  • Headache. This is a relatively rare symptom of an acoustic neuroma. It can occur if the tumour is big enough to block the flow of cerebrospinal fluid in the brain. Cerebrospinal fluid is the clear, nourishing fluid that flows around the brain and spinal cord, protecting the delicate structures from physical and chemical harm. Obstruction to the flow and drainage of cerebrospinal fluid can cause a problem known as 'water on the brain' (hydrocephalus). This results in increased pressure and swelling, and the brain effectively becomes squashed within the skull. This can cause headache and, if untreated, brain damage.
  • Earache. This is another rare symptom of acoustic neuroma. There are many more common causes of earache.
  • Visual problems. Again, these are a rare symptom. If they do happen, it is due to hydrocephalus (see above).
  • Tiredness and lack of energy. These are nonspecific symptoms and can be due to many causes. It is possible that a non-cancerous (benign) brain tumour could lead to this.

What tests are needed to diagnose an acoustic neuroma?

Acoustic neuromas can be difficult to diagnose. If your GP suspects that you have an acoustic neuroma from your symptoms, you would probably be referred to a hospital ear, nose and throat (ENT) surgeon.
The best test to diagnose an acoustic neuroma is a magnetic resonance imaging (MRI) scan of the brain. An MRI scan uses a strong magnetic field and radio waves to take a detailed picture of your brain, and of the structures inside it. It is painless but it can be noisy and can make you feel anxious about being 'closed in' (claustrophobic). No X-rays are used (so it is different to a CT scan which does use X-rays). See also the separate leaflet called MRI Scan for more information.
**Hearing tests** may also be performed if an acoustic neuroma is suspected. This is because one of the most common symptoms of an acoustic neuroma is hearing loss. If an acoustic neuroma is found on a scan, it is useful to know what your hearing in both ears is like before treatment.

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What is the treatment for acoustic neuroma?

If you have a very small acoustic neuroma, your doctors might decide that the best way to treat you is just to observe and monitor it closely. This is because acoustic neuromas are very slow-growing and may not cause any symptoms for a long time. Remember, acoustic neuromas are not malignant and do not spread, so it is quite safe to watch things for a while. Also, treatments can have complications and side-effects. Therefore, the risks and benefits of treatment have to be balanced. If observation is recommended, your condition will be monitored with regular scans.
The main treatments for acoustic neuroma are surgery or stereotactic radiosurgery. The treatment you are offered will depend on:

  • Your suitability for surgery or radiotherapy. Factors such as age and general health govern how fit you are for different treatments.
  • Your tumour. The size and position of your acoustic neuroma will influence the type of treatment offered.
The results of the tests and scans you have can also help to determine which type of treatment is best for you and your tumour.

Surgery

Either a brain surgeon (neurosurgeon) or an ENT surgeon can operate to remove an acoustic neuroma, depending on its size and location on the vestibulocochlear nerve in the brain. The surgery is carried out under a general anaesthetic.
Most people with acoustic neuroma are treated with surgery, and about 95 in 100 tumours can be removed completely. Occasionally (about 5 cases in every 100), a small part of the tumour is left behind. This is usually because it is technically too difficult to remove the whole tumour and/or there is a risk of causing more damage to the nerve or other nearby structures.
If some of the acoustic neuroma is left remaining, it can often be treated with radiotherapy. After surgery for an acoustic neuroma, you will probably have to remain in hospital for a few days for monitoring. You should be fully recovered within 6-12 weeks, and, if your tumour was completely removed, you should not need any more treatment.


Stereotactic radiosurgery

This is a newer type of treatment that can be used for acoustic neuromas. Stereotactic radiosurgery involves delivering a very precise single dose (usually) of radiation to an extremely well-defined area within the brain - where your acoustic neuroma is.
Stereotactic means locating a point using three-dimensional (3D) co-ordinates. In this instance, the point is the acoustic neuroma tumour within the brain. A metal frame (like a halo) is attached to your scalp and a series of scans is performed to show the exact location of the tumour. Stereotactic radiosurgery can be given with a normal radiotherapy machine, the CyberKnife® machine or with a technique known as gamma knife treatment.
Stereotactic radiosurgery is a very specialised type of treatment and is only available in some large hospitals. These hospitals are usually ones with both neurosurgery and cancer treatment (oncology) centres. The main advantage of this treatment is to prevent tumour growth and preserve any remaining (residual) hearing. It tends to shrink rather than remove or destroy the acoustic neuroma. It can be used for very small tumours.

Are any complications likely from an acoustic neuroma?

Complications can be thought of as:
  • Due to the tumour itself.
  • Due to treatments for acoustic neuroma.
  • Return (recurrence) of an acoustic neuroma.

Possible complications due to the acoustic neuroma

  • Hearing loss. The most common symptom of an acoustic neuroma is hearing loss. This is due to damage to the vestibulocochlear nerve that the acoustic neuroma is growing on. Even if the acoustic neuroma is removed with surgery, or destroyed with radiotherapy, a degree of permanent hearing loss in one ear is usual. The extent to which you will be affected by hearing loss varies from person to person. It can depend on things such as how big the tumour is, how much damage has been caused and how difficult treatment was. It is possible to be left with severe or even complete deafness on the side of the acoustic neuroma.
  • 'Water on the brain' (hydrocephalus). If your acoustic neuroma grows very large, a complication called hydrocephalus can occur. This happens because the flow of cerebrospinal fluid is obstructed (see above, under 'Less common symptoms of acoustic neuroma'). Pressure can build up inside the brain, leading to permanent brain damage if not identified and treated. The condition can be treated by inserting a drainage tube (called a shunt) to relieve the pressure and allow the cerebrospinal fluid to flow. Hydrocephalus is very unlikely if you have treatment for an acoustic neuroma.
  • Damage caused by pressure on other nerves in the brain, or on the brainstem. If the acoustic neuroma is growing and untreated, it can cause problems by pressing on nearby structures in the brain. This can lead to some of the symptoms of acoustic neuroma, listed earlier. Long-term pressure can cause permanent damage. It is possible that the trigeminal nerve (which controls feeling in the face) or the facial nerve (which controls movements of the muscles of the face) can be affected. The brainstem is the lower part of your brain that connects to the spinal cord. It controls vital bodily functions. If the brainstem is affected (very rare) then it is possible to have problems with breathing, consciousness, the circulation, co-ordination and balance, and your arm and leg function. Again, if you have treatment for your acoustic neuroma before it has had the chance to grow very big (remember, it is a slow-growing tumour), this sort of complication is very unlikely.

Possible complications due to treatments for acoustic neuroma:

  • Damage to the facial nerve, causing a facial nerve palsy. The facial nerve is the nerve in the brain that controls movements in the muscles of the face. If an acoustic neuroma has grown quite large, removal during surgery can potentially lead to damage of this neighbouring nerve. If the nerve is damaged, there will be paralysis of part of the face. This can cause a problem with drooping of one side of the face. In some cases, physiotherapy will help but, in others, the damage is permanent. Obviously, during surgery, great care is taken to identify and avoid damage to surrounding nerves.
  • Damage to the vestibulocochlear nerve, leading to deafness. As mentioned, a degree of hearing loss is normal after treatment for acoustic neuroma. If you have NF2 and bilateral tumours, there is a strong chance that after surgery, you will completely lose the hearing in both of your ears.
  • Damage to the trigeminal nerve, leading to loss of feeling (facial numbness). In the same way that the facial nerve can be damaged during surgery to remove an acoustic neuroma, the trigeminal nerve can also be injured. If this occurs, there is loss of sensation to parts of the face.

Return (recurrence) of acoustic neuroma

Fewer than 5 in every 100 acoustic neuromas come back. So it is uncommon, but possible. It is more likely if you have NF2. It could cause any of the symptoms mentioned earlier, or any of the complications. After treatment for acoustic neuroma you will generally be followed up in an outpatient clinic to check for any symptoms or signs of a recurrence.

What is the outlook (prognosis) with an acoustic neuroma?

The outlook is generally very good, particularly as it is a non-cancerous (benign) tumour. It is generally very suitable for treatment and complications are uncommon. There is usually a degree of hearing loss in the affected ear after treatment.
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http://www.nytimes.com/health/guides/disease/acoustic-neuroma/overview.html

An acoustic neuroma is a slow-growing tumor of the nerve that connects the ear to the brain. This nerve is called the vestibular cochlear nerve. It is behind the ear right under the brain.
An acoustic neuroma is not cancerous (benign), which means it does not spread to other parts of the body. However, it can damage several important nerves as it grows.



Alternative Names

Vestibular schwannoma; Tumor - acoustic; Cerebellopontine angle tumor; Angle tumor

Back to TopCauses

Acoustic neuromas have been linked with the genetic disorderneurofibromatosis type 2 (NF2).
Acoustic neuromas are uncommon.


Back to TopSymptoms

The symptoms vary based on the size and location of the tumor. Because the tumor grows so slowly, symptoms usually start after age 30.
Common symptoms include:

  • Abnormal feeling of movement (vertigo)
  • Hearing loss in the affected ear that makes it hard to hear conversations
  • Ringing (tinnitus) in the affected ear
Less common symptoms include:

Back to TopExams and Tests

The health care provider may suspect an acoustic neuroma based on your medical history, an examination of your nervous system, or tests.
Often, the physical exam is normal when the tumor is diagnosed. Sometimes, the following signs may be present:

The most useful test to identify an acoustic neuroma is an MRI of the brain. Other tests to diagnose the tumor and tell it apart from other causes of dizziness or vertigo include:
  • Hearing test (audiology)
  • Test of equilibrium and balance (electronystagmography)
  • Test of hearing and brainstem function (brainstem auditory evoked response)

Back to TopTreatment

Treatment depends on the size and location of the tumor, your age, and your overall health. You and your health care provider must decide whether to watch the tumor (observation), use radiation to stop it from growing, or try to remove it.
Many acoustic neuromas are small and grow very slowly. Small tumors with few or no symptoms may be followed, especially in older patients. Regular MRI scans will be done.
If they are not treated, some acoustic neuromas can damage the nerves involved in hearing and balance, as well as the nerves responsible for movement and feeling in the face. Very large tumors can lead to a buildup of fluid (hydrocephalus) in the brain, which can be life-threatening.
Removing an acoustic neuroma is more commonly done for:

  • Larger tumors
  • Tumors that are causing symptoms
  • Tumors that are growing quickly
  • Tumors that are pressing on the brain
Surgery is done to remove the tumor and prevent other nerve damage. Any hearing that is left is often lost with surgery.
Stereotactic radiosurgery focuses high-powered x-rays on a small area. It is considered to be a form of radiation therapy, not a surgical procedure. It may be used:

  • To slow down or stop the growth of tumors that are hard to remove with surgery
  • To treat patients who are unable to have surgery, such as the elderly or people who are very sick
Removing an acoustic neuroma can damage nerves, causing loss of hearing or weakness in the face muscles. This damage is more likely to occur when the tumor is large.

Back to TopOutlook (Prognosis)

An acoustic neuroma is not cancer. The tumor does not spread (metastasize) to other parts of the body. However, it may continue to grow and press on important structures in the skull.
People with small, slow-growing tumors may not need treatment.
Once hearing loss occurs, it does not return after surgery or radiosurgery.


Back to TopPossible Complications

  • Brain surgery can completely remove the tumor in most cases.
  • Most people with small tumors will have no permanent paralysis of the face after surgery. However, about two-thirds of patients with large tumors will have some permanent weakness of the face after surgery.
  • About one-half of patients with small tumors may still be able to hear in the affected ear after surgery.
  • There may be delayed radiation effects after radiosurgery, including nerve damage, loss of hearing, and paralysis of the face.

Back to TopWhen to Contact a Medical Professional

Call your health care provider if you have:
  • Hearing loss that is new or getting worse
  • Ringing in one ear
  • Dizziness (vertigo)

Back to TopReferences

Baloh RW, Jen J. Hearing and equilibrium. In: Goldman L, Schafer AI, eds. Cecil Medicine . 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 430.
Brackmann DE, Arriaga MA. Neoplasms of the posterior fossa. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery . 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 177.
Battista RA. Gamma knife radiosurgery for vestibular schwannoma.Otolaryngol Clin North Am . 2009;42:635-654.
Sweeney P, Yajnik S, Hartsell W, Bovis G, Venkatesan J. Stereotactic radiotherapy for vestibular schwannoma. Otolaryngol Clin North Am . 2009;42:655-663.
Conley GS, Hirsch BE. Stereotactic radiation treatment of vestibular schwannoma: indications, limitations, and outcomes. Curr Opin Otolaryngol Head Neck Surg . 2010 Oct;18(5):351-6.



http://www.webmd.com/brain/acoustic-neuroma-causes-symptoms-treatments


An acoustic neuroma is a noncancerous growth that develops on the eighth cranial nerve. Also known as the vestibulocochlear nerve, it connects the inner ear with the brain and has two different parts. One part is involved in transmitting sound; the other helps send balance information from the inner ear to the brain.
Acoustic neuromas -- sometimes called vestibular schwannomas or neurolemmomas -- usually grow slowly over a period of years. Although they do not actually invade the brain, they can push on it as they grow. Larger tumors can press on nearby cranial nerves that control the muscles of facial expression and sensation. If tumors become large enough to press on the brain stem or cerebellum, they can be deadly.


Acoustic Neuroma Symptoms

The early symptoms of an acoustic neuroma are often subtle. Many people attribute the symptoms to normal changes of aging, so it may be a while before the condition is diagnosed.
The first symptom is usually a gradual loss of hearing in one ear, often accompanied by ringing in the ear (tinnitus) or a feeling of fullness in the ear. Less commonly, acoustic neuromas may cause sudden hearing loss.
Other symptoms, which may occur over time, include:

  • Problems with balance
  • Vertigo (feeling like the world is spinning)
  • Facial numbness and tingling, which may be constant or come and go
  • Facial weakness
  • Taste changes
  • Difficulty swallowing and hoarseness
  • Headaches
  • Clumsiness or unsteadiness
  • Confusion
It's important to see your doctor if you experience these symptoms. Symptoms like clumsiness and mental confusion can signal a serious problem that requires urgent treatment.

Acoustic Neuroma Causes

There are two types of acoustic neuroma: a sporadic form and a form associated with a syndrome called neurofibromatosis type II (NF2). NF2 is an inherited disorder characterized by the growth of noncancerous tumors in the nervous system. Acoustic neuromas are the most common of these tumors and often occur in both ears by age 30.
NF2 is a rare disorder. It accounts for only 5% of acoustic neuromas. This means the vast majority are the sporadic form. Doctors aren't certain what causes the sporadic form. One known risk factor for acoustic neuroma is exposure to high doses of radiation.

Acoustic Neuroma Treatments

There are three main courses of treatment for acoustic neuroma:
  • Observation
  • Surgery
  • Radiation therapy
Observation is also called watchful waiting. Because acoustic neuromas are not cancerous and grow slowly, immediate treatment may not be necessary. Often doctors monitor the tumor with periodic MRI scans and will suggest other treatment if the tumor grows a lot or causes serious symptoms.
Surgery for acoustic neuromas may involve removing all or part of the tumor.
There are three main surgical approaches for removing an acoustic neuroma:

  • Translabyrinthine, which involves making an incision behind the ear and removing the bone behind the ear and some of the middle ear. The upside of this approach is that it allows the surgeon to see an important cranial nerve (the facial nerve) clearly before removing the tumor. The downside of this technique is that it results in permanent hearing loss.
  • Retrosigmoid/sub-occipital, which involves exposing the back of the tumor by opening the skull near the back of the head. This approach can be used for removing large tumors and offers the possibility of preserving hearing.
  • Middle fossa, which involves removing a small piece of bone above the ear canal to access and remove small tumors confined to the internal auditory canal, the narrow passageway from the brain to the middle and inner ear. Using this approach may enable surgeons to preserve a patient's hearing.
A newer, less invasive technique called total endoscopic resection enables surgeons to remove acoustic neuromas using a small camera inserted through a hole in the skull. This technique is offered only at major medical centers with specially trained surgeons. Initial studies show success rates similar to those with conventional surgery.
Radiation therapy is recommended in some cases for acoustic neuromas. State-of-the-art delivery techniques make it possible to send high doses of radiation to the tumor while limiting expose and damage to surrounding tissue.
Radiation therapy for this condition is delivered in one of two ways:

  • Single fraction stereotactic radiosurgery (SRS), in which many hundreds of small beams of radiation are aimed at the tumor in a single session.
  • Multi-session fractionated stereotactic radiotherapy (FRS), which delivers smaller doses of radiation daily, generally over several weeks. Early studies suggest multi-session therapy may preserve hearing better than SRS.

Acoustic Neuroma Treatments continued...

Both of these are outpatient procedures, which means they don't require a hospital stay. They work by causing tumor cells to die. The tumor's growth may slow or stop or it may even shrink, but radiation doesn't completely remove the tumor.
Selecting the right treatment depends on a number of factors, including:

  • Size of the tumor
  • Whether the tumor is growing
  • Your age
  • Other medical conditions you may have
  • Severity of your symptoms and their impact on your life

SOURCES:
UCLA Health System: "Acoustic Neuroma Brain Tumor."
Acoustic Neuroma Foundation: "What Is Acoustic Neuroma?"
Acoustic Neuroma Association: "Symptoms of Acoustic Neuroma."
American Hearing Research Foundation: "Acoustic Neuroma."
Genetics Home Reference: "Neurofibromatosis type 2."

Acoustic Neuroma Association: "Treatment Options."





http://www.webmd.com/cancer/neurofibrosarcoma-and-schwannoma


Neurofibrosarcoma and Schwannoma


Schwannomas and neurofibrosarcomas are nerve sheath tumors, which means they involve the coating around nerve fibers that transmit messages to and from the brain and spinal cord (nervous system) and the rest of the body. Schwannomas are most often nonmalignant tumors. Neurofibrosarcomas are malignant tumors.


How Schwannomas and Neurofibrosarcomas Develop

Schwannomas form in the tissue that surrounds and insulates nerves. Schwannomas develop when schwann cells -- the cells that form the covering around nerve fibers -- grow abnormally.
Schwannomas typically develop along nerves of the head and neck. A type of schwannoma called vestibular schwannoma (or acoustic neuroma) affects the nerve that connects the brain to the inner ear, which can affect your sense of balance. Although schwannomas do not spread, they can grow large enough to press down on important structures in the brain (including the brain stem).


A very small percentage of nerve sheath tumors are malignant. These are known as malignant peripheral nerve sheath tumors, or neurofibrosarcomas.
Because neurofibrosarcoma originates in nerves, it is considered part of a group of cancers called soft tissue sarcomas. Soft tissue sarcomas are uncommon. They make up less than 1% of all cancers diagnosed each year. Neurofibrosarcomas account for only a small number of these soft sarcomas.
Neurofibrosarcoma is usually found in the arms and legs. However, it also can affect the lower back, head, or neck.
Neurofibrosarcomas can spread along the nerves. They typically don't reach other organs, although they can spread to the lungs.

What Causes Nerve Sheath Tumors?

Doctors don't know what causes most schwannomas and neurofibrosarcomas. However, nerve sheath tumors are more common in people who have the inherited disorder, neurofibromatosis type 1 (previously known as von Recklinghausen disease).
Vestibular schwannomas are linked to neurofibromatosis type 2. Having a genetic disorder called schwannomatosis also can increase the risk for schwannomas. A small percentage of neurofibrosarcomas are related to past radiation exposure.
Nerve sheath tumors are usually diagnosed when people are between the ages of 30 and 50, although these diseases can sometimes affect children and elderly people.

What Are the Symptoms of Nerve Sheath Tumors?

Symptoms of schwannomas can include:
  • A painless or painful growth or swelling on the face
  • Hearing loss or ringing in the ear (vestibular schwannoma)
  • Loss of coordination and balance (vestibular schwannoma)
  • Numbness, weakness, or paralysis in the face
Symptoms of neurofibrosarcomas can include:
  • Swelling or a lump in the arms or legs
  • Pain or soreness
  • Difficulty using the arms, legs, feet, or hands


How Are Nerve Sheath Tumors Diagnosed?
Doctors diagnose nerve sheath tumors by doing a physical and neurological (brain and nervous system) examination. Usually they'll also perform imaging tests such as CT or MRI scans to pinpoint the location and size of the tumor. A biopsy (removing a tissue sample and examining it in the lab) can confirm whether the tumor is malignant.

How Are Schwannomas and Neurofibrosarcomas Treated?

Schawnnomas may not need treatment if they are not causing any symptoms. Surgery is sometimes needed if the tumor is pressing on a nerve causing pain or other problems. The most common treatment for neurofibrosarcomas is to remove them with surgery. Radiation therapy is often used after surgery to help decrease the risk of recurrence. However, surgery can be difficult if the tumor is very close to or surrounding an important nerve, because the surgeon could damage the nerve while trying to remove the tumor. In addition to surgery and radiation therapy, chemotherapy may also be needed. When a tumor can't be removed, high-dose radiation therapy may be used to target the tumor.
With neurofibrosarcomas, the doctor will remove the tumor and the tissue around it. Surgeons will try to remove the tumor without damaging too much of the affected arm or leg (called limb-salvage or limb-sparing surgery), but if the tumor can't be removed, the arm or leg might need to be amputated. Radiation and chemotherapy may be done before surgery to shrink the tumor so it can be removed more easily, or after surgery to kill any cancer cells that are left behind.
Schwannomas usually don't come back if they are removed completely. The prognosis after treatment for neurofibrosarcoma depends on the size of the tumor, where it is located, and how far it has spread. Long-term survival can vary from person to person. It's possible for the cancer to return, even after aggressive treatment.
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