Acoustic neuroma
An acoustic neuroma is a benign tumour that grows from the sheath of the nerve responsible for hearing and balance.
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An acoustic neuroma is a benign tumour that grows from the sheath of the nerve responsible for hearing and balance. Its more precise name is vestibular schwannoma. It does not invade neighbouring tissue and does not spread elsewhere in the body, but it grows in a very tight space at the base of the skull, so even a small nodule presses on the nerve and gradually takes hearing away on one side. Growth is slow: in many people the size barely changes over years of monitoring.
What it feels like
The tumour rarely announces itself. It sits for years in a narrow bony canal, and people get used to one ear working less well. That is why it is usually found late — not because it is aggressive, but because the complaints look entirely ordinary.
- hearing drops in one ear while the other stays the same;
- on the phone you find yourself switching the handset to the "good" ear;
- speech becomes hard to follow in a noisy room even though the volume seems fine;
- a constant ringing, buzzing or hissing appears in the same ear;
- walking feels slightly less steady, especially in the dark and on uneven ground;
- sudden spinning attacks are usually absent, because the brain compensates for a slow loss of balance.
As the nodule enlarges it starts to touch the neighbouring nerves: one side of the face goes numb, the eye becomes less sensitive, and less often facial movement changes. A large tumour presses on the brainstem and blocks the drainage of spinal fluid, which adds headache and nausea.
When waiting is the wrong choice
Some signs call for care straight away rather than "sometime this week".
- Hearing in one ear disappears over hours or a day or two. Sudden one-sided deafness is an emergency: there is only a window of a few days to try to restore hearing, and a share of these cases turns out to be the first sign of an acoustic neuroma.
- A worsening headache with nausea, vomiting, drowsiness or double vision. That is how raised pressure inside the skull shows itself.
- The face has suddenly dropped on one side and the eye no longer closes fully.
- Swallowing has become difficult, the voice has changed, or unsteadiness has sharply worsened.
Gradual hearing loss or noise in one ear alone also deserves an appointment, though not an urgent one. What matters here is not how loud the complaint is, but that it affects one side only.
Where it comes from
In most cases no cause can be named. The tumour appears by chance, unrelated to lifestyle, injuries, headphones or past ear infections. It is found most often in adults between thirty and sixty.
One rare but important situation stands apart: neuromas on both sides at once. These are almost always a sign of an inherited condition in which schwannomas grow on many nerves, previously known as neurofibromatosis type 2. It begins at a young age, calls for follow-up in a specialist centre and for testing of close relatives. So if the finding is bilateral, or if a neuroma turns up in a teenager or a young adult, the doctor will refer for genetic counselling.
How it is found
The starting point is audiometry, which shows whether the two ears differ and what kind of hearing loss is present. If the loss is one-sided and originates in the inner ear or the nerve, the next step is an MRI scan with contrast, aimed at the internal auditory canals. This is the main test and it picks up nodules only a few millimetres across.
A CT scan is considerably weaker for this purpose and stays as a fallback, for instance when MRI cannot be done. Balance testing shows how far the vestibular system has been affected but does not establish the diagnosis.
Other conditions cause similar complaints: Ménière's disease, age-related hearing loss, the effects of loud noise, and migraine with vertigo. They cannot be told apart without a scan, and that is the point of the referral.
Watch, irradiate or operate
There is no single right answer. The choice depends on the size of the nodule, how fast it grows, the state of your hearing, your age and other illnesses.
- Monitoring. For small tumours this is a full strategy, not a refusal to treat. Repeat MRI scans at agreed intervals show whether the nodule is growing or holding still. A sizeable share of these tumours never enlarges at all.
- Stereotactic radiosurgery. Precisely targeted radiation for a small or medium tumour. The aim is to halt growth rather than remove the nodule: on scans it usually remains but stops enlarging.
- Surgery. Removal under general anaesthetic through an approach near the temporal or occipital bone. It is the main choice for large tumours and when the brainstem is being compressed. Sometimes the nodule is deliberately removed incompletely to spare the facial nerve, and the remnant is irradiated afterwards.
Every option has a price. Both surgery and radiation can worsen hearing to the point of complete deafness in that ear, disturb the facial nerve, and increase noise and unsteadiness. Monitoring carries none of those risks but demands discipline and regular scans. It is worth framing the conversation with the neurosurgeon in exactly those terms: what you lose and what you gain in each scenario.
What remains after treatment
One thing to be ready for: hearing lost before the intervention usually does not come back, and noise in the ear often persists after the tumour is removed. That is not a sign of failure — the nerve was already damaged before the operation.
These problems are handled separately. Hearing aids are fitted, including systems that route sound to the hearing ear. Unsteadiness improves with vestibular rehabilitation: the brain learns to work with the signal from one side, and exercises speed that adjustment up. For noise in the ear, masking techniques help, along with work on the anxiety that amplifies it.
Follow-up continues after treatment: MRI is repeated on a schedule so that renewed growth is not missed. Recurrence after complete removal is uncommon.
Common questions
Is it cancer? No. The tumour is benign, it does not invade neighbouring organs and it does not spread. It becomes dangerous only through its size and the pressure it puts on brain structures.
Are headphones or mobile phones to blame? There is no convincing evidence of such a link.
Can I drive? Usually yes, but not with marked vertigo and not in the first weeks after surgery. This is decided with your doctor case by case.
Is it inherited? A single-sided neuroma, as a rule, is not. Inheritance comes into the picture with tumours on both sides and with onset at a young age.
Online consultation
In an online appointment a doctor can go through how your hearing has changed, whether the two ears differ and whether there is noise, judge whether audiometry and a contrast MRI are needed, explain what else causes these complaints, and advise which specialist to see in person and how urgently.
This material is for information only and does not replace medical advice.
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