A vestibular schwanomma (also referred to as an acoustic neuroma) is a slow growing tumor of the hearing or balance nerve. It is the most common benign growth seen by otolaryngologists at Henry Ford. This tumor occurs in about three out of every 100,000 people, and there are about 2,000 – 3,000 new patients with this problem each year.
Acoustic neuromas are thought to arise from a genetic change that occurs in our chromosomes. It has been determined that the long arm of chromosome 22 incurs a loss in a tumor suppressor gene. Essentially, this means that there is a change in the genetic code. The reason that this happens is not understood. Some patients get this on both sides, and this means that they have neurofibromatosis type 2. If a patient has tumors on both sides, then other family members should be checked with an MRI as well.
The typical symptoms of acoustic neuromas are hearing loss and/or tinnitus (ringing or buzzing)in one ear. Sometimes there are also balance problems or facial spasms, weakness or paralysis.
Initial evaluation for this type of tumor includes a complete history and physical in relation to the ear, nose, throat and skull base region. A hearing test is imperative, and sometimes we will perform an auditory brainstem response test (ABR). This is a fairly accurate screening test, but it is not perfect. The best test for making the diagnosis is an MRI. As part of the preoperative evaluation, an otolaryngologist may also request an Electronystagmogram (ENG), which is a special balance test to discover how much the balance nerve is involved.
Henry Ford offers several approaches for the removal of acoustic neuromas:
Translabyrinthine: This is the standard way most of these tumors are removed. The disadvantage to this approach is the patient is guaranteed to have complete loss of hearing in the operated ear. Even a hearing aid will not help. The advantage is that it has the least risk to causing facial paralysis.
Retrolabyrinthine: This is typically used for tumors that are closer to the brainstem and more in the area called the cerebellar pontine angle. This approach has the positive aspect of being able to possibly save hearing but hearing preservation with this approach or with the middle cranial approach range from 0-75 percent and really depends upon the size of the tumor.
Middle Cranial Fossa approach: This approach is typically used for tumors that are 1.3 cm or less in size and limited to the internal auditory canal. The biggest concern for removal of these types of tumors is hearing loss and weakness of the facial muscles. This approach, however, gives Henry Ford doctors the ability to percent percentprevent these problems in the vast majority of patients.
For all of these approaches, the Henry Ford otolaryngologists work closely with a neurosurgeon.
Usually after surgery, patients will complain of some headaches, but these rapidly improve. The most common problems deal with facial weakness and paralysis, eye closure, burning of the eye (because it is not tearing normally), balance problems and generalized fatigue. These are all normal feelings after surgery and will improve with time. If a patient should have facial paralysis, which is the most common side effect of surgery other than hearing loss, there is a chance for repeated procedures. A Henry Ford otolaryngologist will closely monitor each patient following surgery both immediately and over the following year.
Tinnitus
Tinnitus, from the Latin word "tinnire" which means “to ring or tinkle like a bell,” is a hearing ailment that affects over 35 million Americans. Most often, it affects people over the age of 40, but it is also seen in young people who are exposed to loud, amplified music.
Tinnitus is characterized by annoying ear noises -- ringing, buzzing, whistling, hissing or other noises heard in the ear in the absence of environmental sources -- which can be soft or loud enough to be completely debilitating. Tinnitus can also cause sleep disturbance and interfere with concentration.
Tinnitus is not a disease in itself, but a symptom that something is wrong in the auditory system. While theories exist, the actual mechanism responsible for tinnitus remains unknown, as does the origin of the ear noises. Tinnitus is not just in the patient's imagination. Although there is no known cure for tinnitus, the specialists at Henry Ford can offer many methods for coping with the condition.
Tinnitus can occur in a single episode, for a few days or weeks, or permanently. It can occur in one ear (unilaterally) or both ears (bilaterally). While more common in both ears, the rare unilateral ailment can be more serious.
What can cause tinnitus?
Acoustic trauma from noises such as loud music, concerts and gunshots
Long-term exposure to noises from welding equipment, power saws, jackhammers, vacuum cleaners, power mowers, snow blowers and some kitchen appliances
Allergies
Diabetes
High cholesterol
High blood pressure
Earwax buildup
Tumors
Meniere's disease
Medications (sometimes too much aspirin)
Old age (the natural degeneration of hearing)
When specialists can identify the cause of tinnitus (e.g., earwax buildup, high cholesterol or the presence of a tumor), relief may be possible through treatment available for those conditions. In addition to taking a complete medical history, your physician will do a physical exam that will include screening for hearing loss or other deficiencies. You also may be referred for formal hearing tests.
Henry Ford runs the only well established clinic for bothersome tinnitus in Michigan, which has been operating for nearly a decade.
Meniere's Disease
Meniere's disease or syndrome is a condition characterized by hearing impairment, ringing in the ears (tinnitus) and periodic vertigo (disturbance of balance and equilibrium). The disease results from distention of the endolymphatic compartment of the inner ear – referred to as endolymphatic hydrops. A precise cause of hydrops cannot be found in most cases.
A reliable diagnosis can be made from history alone when there is a clear-cut symptom triad: characteristic vertigo; tinnitus; and fluctuating, unilateral hearing loss. Approximately 75 percent of patients also report a sensation of fullness in the affected ear or ears.
Treatment The specialists at Henry Ford typically recommend a multifaceted approach to treating Meniere’s disease, with general attention given to overall physical and mental well being, proper diet, salt restriction (less than 2 grams of sodium daily), avoidance of known triggers and stress management. Some patients may require diuretics (“water pills”) to help control symptoms by reducing pressure in the ear.
Surgery can be considered if a patient is significantly bothered by vertigo and conventional medical management has not been effective.
