Emily Caputo

Professor Dunphy
Acoustic Neuroma Case Study
January 7, 2014
Abstract: An acoustic neuroma is also known as a vestibular schwannoma. These benign brain
tumors are believed to be composed of schwann cells that press against the vestibulocochlear
nerve. Acoustic neuromas are responsible for symptoms such as tinnitus, which is a ringing in
the ears, unilateral or bilateral hearing loss, and problems with balance and facial numbness. This
case study will review a patients symptoms and outcome as he is diagnosed with an acoustic
neuroma.
Patient Characteristics: A 60 year old man was previously diagnosed with Parkinsons disease.
He had been treated continually for slow movement and stiffness of his arms and legs by his
neurologist and occupational therapist before being referred to an ENT for new symptoms. His
neurologist prescribed him L-dopa for management of those symptoms.
Examination: The patient presented emerging symptoms included tinnitus, unilateral hearing
loss, slight facial numbness, and a development of balance problems. The patient brought in a
past audiogram to compare with the more recent one. Due to issues with the patients worsening
symptoms, his neurologist ordered an updated MRI scan to check for any abnormalities. He
reported he was unsteady on his feet and needed to use a walker to aid in his mobility. Pertaining
to his unilateral loss of hearing, the patient underwent an updated audiogram, which tested his
hearing at different frequencies. The test came back showing the patient was suffering from
sensorineural hearing loss, meaning he could not hear any noises at high frequencies. An
additional electronystagmography test was performed in order to determine if he had any
problems with balance or equilibrium. His results came back abnormal, meaning there was
damage to the nerve of the inner ear. An MRI scan was ordered to get a better look at any
abnormalities.
Clinical Impression: Due to the results of the electronystagmography and audiogram test
coupled with the symptoms presented by the patient, an acoustic neuroma became a possible
diagnosis and could be confirmed once the MRI tests were examined.
Examination findings: Upon studying the MRI, a 3cm acoustic neuroma was found along the
vestibulocochlear nerve and trigeminal nerve, which was responsible for the patients hearing loss
and other symptoms.
Interventions and Outcomes: The acoustic neuroma was removed surgically, and most of the
facial features were restored. The surgery was done via the retrosigmoid approach, which helped
preserve what auditory function was left. This was also done because of the large size of the
tumor. After a weeklong recovery in the hospital with no complications, the patient was sent
home.
Disscussion: An acoustic neuroma is a non-cancerous tumor that arises from the sheath around
the Vestibulocochlear nerve. This is the nerve that is responsible for hearing and balance. If the
tumor is large enough, it can press on the trigeminal nerve, which causes facial numbness.
Tinnitus, deafness, balance problems and facial numbness are general symptoms, and if the
tumor is large enough and presses against the brain, it can cause headaches and mental
confusion. There are three main ways that an acoustic neuroma can be treated. Due to relatively
slow growth, they can be watched and monitored to see if it gets better. The tumor can be
removed by surgery, however complications can lead to permanent deafness and facial paralysis.
Radiation treatment is also available.


Refrences:
Joerg-Christian, Tonn, Schlake Hans-Peter, and Roland Goldbrunner. "Acoustic Neuroma
Surgery as an Interdisciplinary Approach: A Neurosurgical Series of 508 Patients." -- Tonn Et
Al. 69 (2): 161. N.p., n.d. Web. 05 Feb. 2014.
Wright A, Bradford R: Management of acoustic neuroma. British Medical Journal
1995;311:1141-1144 http://bmj.com/cgi/content/full/311/7013/1141#F1Read more:
http://www.netdoctor.co.uk/diseases/facts/acousticneuroma.htm#ixzz2sVlVWJsP Follow us:
@NetDoctor on Twitter | NetDoctorUK on Facebook
Tonn J-C, Schlake H-P, Goldbrunner R, et al. (2000) Acoustic neuroma surgery as an
interdisciplinary approach: a neurosurgical series of 508 patients. J Neurol Neurosurg
Psychiatry 69:161166.
Bance M, Ramsden RT. Management of neurofibromatosis type 2. Ear Nose Throat J. Feb
1999;78(2):91-4, 96.
"Acoustic Neuroma: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine.
U.S. National Library of Medicine, n.d. Web. 06 Feb. 2014.