Acoustic neuroma is a very uncommon, benign, and passively expanding tumor that causes hearing and balance loss. The cerebellopontine angle is typically involved in this disease and affects the eight cranial (auditory/vestibulocochlear) nerves.
Is there treatment for acoustic neuroma?
The treatment of acoustic neuroma consists of either surgical removal of the tumor or radiotherapy to kill the tumor cells. Sometimes hearing loss may develop as a new symptom or it might increase in severity due to the damage to involved nerves during surgical removal of the tumor. So it is entirely the patient’s decision whether to go ahead with the treatment or not.
Observation or WAIT and WATCH
In cases where no symptoms are evident or if the tumor is not developing or growing slowly, this alternative may be selected by the affected person.
This is called the "wait and watch" approach as treatment is delayed and the patient is kept under observation. Watch and wait may be good for older people who do not exhibit symptoms.
Surgical excision
The goal of the surgery is to safeguard the facial nerve and prevent facial paralysis when total tumor excision is recommended.
Additionally, the surgeon works to keep as much of the damaged ear's hearing as feasible. For patients with an acoustic neuroma, the reterosigmoid (suboccipital), middle fossa, and translabyrinthine surgical techniques are frequently employed.
When choosing a method for surgery, the size and location of the tumor as well as various other factors such as the patient’s age, and general health status of the patient, also need to be considered.
Radiotherapy
For those who have an acoustic neuroma, radiation therapy offers a noninvasive treatment option, albeit for some patients it may take weeks, months, or even a few years to see substantial results. Radiation therapy for these tumors has the potential to cause some of them to recur later on[1].
Recent advances
Molecular targeted agents like trastuzumab, lapatinib, imatinib mesylate, and bevacizumab which inhibit several growth receptors involved in the pathogenesis of acoustic neuroma can cause shrinkage of the tumor by killing the tumor cells and thereby improve the hearing loss[2].
Can patients survive after treatment?
The success of treatment in acoustic neuroma depends on the immune status of the patient, the size of the tumor, and the preservation of important vital structures and nerves during the surgical approach of tumor removal. The 30-day mortality rate following surgery for acoustic neuroma is 1 of 200(0.5%). Sometimes radiotherapy apart from making the tumor cells necrotic may develop other cancers in patients. The usage of newly developed molecular target agents may avoid complications like those stated above, but they are associated with many side effects. As the tumor is very slow growing and benign, complete removal of the tumor with the treatment options will help to increase the life span of the patients (increase survival rate) to a greater extent and death is very rare in these patients.
What are the challenges faced by the patient after treatment?
Surgical therapy
Caregivers should be properly trained to help the patients in all aspects during the post-surgery recovery period which varies between 4-6 weeks depending on the immune status of the patient. The patients should be advised to avoid traveling for at least 3 months, and also the caregivers should be given proper instructions. Complications of surgery should be addressed properly in order to avoid unnecessary stress and anxiety in the patients and to improve the mental and emotional aspects of the quality of life of these patients[1]. The hearing will be re-established after the surgical removal of the tumor. Sometimes hearing may be permanently lost after surgery in acoustic neuroma due to the damage to the underlying structures. If this occurs, the patient faces a lifetime challenge of deafness most commonly unilateral or sometimes bilateral. The patient may require psychological counseling. Vestibular rehabilitation is done with artificial hearing aids. If the patient is concerned about the esthetic display of hearing aids, newer advances like cochlear implants and auditory brainstem implants may be considered. Stimuli from external sources are transmitted to the brain via these implants in the form of electric waves and the brain sends signals back which are experienced as hearing by the patient[3].
Radiotherapy The patient should be explained about the radiation damage that occurs to normal cells due to radiotherapy, and continuous monitoring during and after radiotherapy is required to check for the development of any other new tumors. If it occurs, radiotherapy is immediately stopped and treatment should be initiated for the new tumors also[1]. Cognitive therapy The symptoms of balance loss can be treated with vestibular therapy. It is a unique type of therapy used to treat vertigo, vertigo-like symptoms, eyesight problems, and postural issues. Acoustic neuromas can also be treated with behavioral therapy. This therapy can be used to treat symptoms such as stress, anxiety, sadness, and depression which develop in these patients due to the loss of hearing and balance. Anti-anxiety and antidepressant drugs can also be considered in such scenarios[4].
Time heals everything
As time progress after the treatment, the patient will regain hearing and balance and may start leading a normal life. In case of permanent hearing loss, the patient will become emotionally stable in due course of time and gets adapted to hearing aids or implants. Thus, the quality of life of patients with acoustic neuroma will improve slowly.
References
E. Myrseth, P.-H. Pedersen, P. Møller, and M. Lund-Johansen, “Treatment of vestibular schwannomas. Why, when, and how?,” Acta Neurochir. (Wien), vol. 149, no. 7, Art. no. 7, Jul. 2007, doi: 10.1007/s00701-007-1179-0.
J. Long, Y. Zhang, X. Huang, J. Ren, P. Zhong, and B. Wang, “A Review of Drug Therapy in Vestibular Schwannoma,” Drug Des. Devel. Ther., vol. 15, pp. 75–85, 2021, DOI: 10.2147/DDDT.S280069.
D. M. Zeitler and M. F. Dorman, “Cochlear Implantation for Single-Sided Deafness: A New Treatment Paradigm,” J. Neurol. Surg. Part B Skull Base, vol. 80, no. 2, pp. 178–186, Apr. 2019, DOI: 10.1055/s-0038-1677482.
E. J. McLaughlin, D. C. Bigelow, J. Y. K. Lee, and M. J. Ruckenstein, “Quality of life in acoustic neuroma patients,” Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol., vol. 36, no. 4, Art. no. 4, Apr. 2015, doi: 10.1097/MAO.0000000000000674.
