Acoustic neuroma
Background
- AKA vestibular schwannoma
- Schwann cell derived tumor of cranial nerve VIII
- Typically arise from vestibular division of CN VIII--> expands--> projects from internal auditory canal into cerebellopontine angle--> compresses CN VII and VIII
- Less commonly, can continue to enlarge and compress cerebellum, brain stem, and CN V, IX, and/or XII
Clinical Features
- Hearing loss, sensorineural, slowly progressive or abrupt
- Vertigo/dysequilibrium
- Tinnitus, unilateral
- Otalgia or sensation of ear fullness/pressure
- Facial weakness or numbness if facial nerve involvement
Differential Diagnosis
Vertigo
- Vestibular/otologic
- Benign Paroxysmal Positional Vertigo (BPPV)
- Traumatic (following head injury)
- Infection
- Meniere's disease
- Ear foreign body
- Otic barotrauma
- Neurologic
- Cerebellar stroke
- Vertebrobasilar insufficiency
- Lateral Wallenberg syndrome
- Anterior inferior cerebellar artery syndrome
- Neoplastic: cerebellopontine angle tumors
- Basal ganglion diseases
- Vertebral Artery Dissection
- Multiple sclerosis
- Infections: neurosyphilis, tuberculosis
- Epilepsy
- Migraine (basilar)
- Other
- Hematologic: anemia, polycythemia, hyperviscosity syndrome
- Toxic
- Chronic renal failure
- Metabolic
Sensorineural hearing loss
- Sudden Sensorineural Hearing Loss (SSHL)
- Infections: (Meningitis, Viral cochleitis)
- Barotrauma
- Penetrating trauma
- Meniere Disease
- Autoimmune disease
- Multiple Sclerosis
- Cerebrovascular ischemia
- Tumors (Acoustic neuroma, Meningioma)
- Hereditary hearing loss
- Congenital viral infections
- Congenital malformations
- Presbycusis
- Thyrotoxicosis
- Ototoxic drugs: Aminoglycosides, Erythromycin, Tetracycline, chemotherapeutic agents, high-dose aspirin, phosphodiesterase-5 inhibitors (e.g. sildenafil, antimalarial drugs, Cocaine, Heavy Metals
- Otologic surgery
- Noise exposure
Evaluation
- Brain MRI
- Outpatient audiogram
Management
- Typically monitored without resection unless rapidly growing or bothersome symptoms
Disposition
- Discharge
See Also
External Links
References
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