When Hearing Loss Means More: Understanding Acoustic Neuromas (vestibular schwannomas)

Acoustic neuromas, also known as vestibular schwannomas, are noncancerous tumors that develop on the nerve connecting the inner ear to the brain. While benign, these tumors can significantly affect hearing, balance, and overall quality of life if left untreated. Understanding what they are, how they are diagnosed, and the treatment paths available can help patients and families feel more confident in their care journey.

What Are Acoustic Neuromas?

Acoustic neuromas arise from the vestibulocochlear nerve, which is responsible for both hearing and balance. Because they tend to grow slowly, symptoms often appear gradually and may be overlooked in the early stages. The most common signs include:

• Hearing loss in one ear (often the first symptom noticed)

• Ringing in the ear, known as tinnitus

• Problems with balance or dizziness

• In some cases, facial numbness or tingling if the tumor presses on nearby nerves

Although not cancerous, their location makes them important to monitor closely, as growth can eventually interfere with surrounding brain structures.

How Are Acoustic Neuromas Diagnosed?

Because symptoms often develop slowly, an acoustic neuroma can sometimes be difficult to detect without imaging. The diagnostic process typically includes:

• Hearing Test (Audiogram): A simple test that can reveal hearing loss on one side, often the first clue.

• MRI with Contrast: The gold standard for diagnosis. MRI can detect very small tumors, define their size and exact location, and help guide treatment planning.

• CT Scan: While not as sensitive as MRI, CT scans can sometimes detect larger tumors or show the impact on nearby bone structures. They may also be used if a patient cannot undergo an MRI.

Together, these tools provide a clear picture and help the care team decide the best approach for monitoring or treatment.

Treatment Paths

The good news is that patients today have multiple treatment options, depending on the size of the tumor, symptoms, and overall health.

• Observation (Watchful Waiting) For small tumors that aren’t causing significant symptoms, observation is often the first step. This approach involves regular MRIs and hearing tests to track whether the tumor is growing. For many patients, this means living life as normal while keeping a careful eye on changes.

• Radiosurgery Noninvasive treatments such as Gamma Knife radiosurgery use highly focused beams of radiation to stop or slow the tumor’s growth. This option is typically outpatient and allows patients to return home the same day, making it less disruptive than traditional surgery.

• Surgery - When tumors are larger or symptoms are more severe, surgery may be recommended. Modern surgical techniques aim not only to remove the tumor but also to preserve important functions such as hearing and facial nerve health whenever possible. The decision is highly individualized, with the goal of balancing tumor control with maintaining quality of life.

Balancing Treatment and Quality of Life

No two patients with an acoustic neuroma are exactly alike, and treatment is never one-size-fits-all. Factors such as age, tumor size, overall health, and personal goals all influence the decision-making process. For some, maintaining hearing is the highest priority; for others, stopping the tumor’s growth is most important. A patient-centered approach means weighing these factors carefully, having open conversations with the care team, and involving loved ones in the process. Recovery often extends beyond the procedure itself, with rehabilitation services such as hearing support and balance therapy helping patients return to daily life.

The Bottom Line

Living with an acoustic neuroma can feel overwhelming at first, but advances in neurosurgery mean patients have more options—and better outcomes—than ever before. With careful monitoring, minimally invasive techniques, and surgical expertise, treatment can be tailored to protect both health and quality of life.

As a neurosurgeon with fellowship training in cerebrovascular, skull base, and endovascular neurosurgery, I understand the complexity of spine-related disorders that straddle both orthopedic and neurological domains. My practice is designed to support referring providers by offering quick access, collaborative case review, and a patient-centered approach.

This blog is intended for general informational and educational purposes only. It is not medical advice and should not be used as a substitute for professional diagnosis or treatment. Reading or commenting on this blog does not create a doctor–patient relationship. Please consult your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.