Acoustic Neuroma (Vestibular Schwannoma)

An acoustic neuroma, also called a vestibular schwannoma, is a benign tumour that grows from the covering of the balance nerve between the inner ear and the brainstem. It is not cancer and does not spread, but it sits in a tight space beside the nerves for hearing, balance and facial movement.

Most grow slowly, often 1 to 2 millimetres a year, and some do not grow at all. The central decision is therefore not how to remove it quickly but whether to treat it at all, and if so how to protect hearing and the facial nerve.

Symptoms

• Gradual hearing loss in one ear, often first noticed on the telephone
• Ringing or hissing (tinnitus) in the same ear
• Unsteadiness or a vague sense of imbalance rather than spinning vertigo
• A feeling of fullness in the ear
• Facial numbness or tingling with larger tumours
• Headache, clumsiness or double vision when a large tumour presses on the brainstem

Causes and risk factors

The tumour arises from Schwann cells, which insulate the vestibular nerve. In most people it appears for no identifiable reason, usually between the ages of 30 and 60, and affects one side only. Tumours on both sides, or a tumour in a young person, point to neurofibromatosis type 2, an inherited condition that needs genetic advice and lifelong surveillance. Previous high dose radiation to the head is a rare risk factor. Mobile phone use has not been shown to cause it.

How it is diagnosed

• Audiometry: A hearing test showing loss in one ear that is worse for speech than expected is often the first clue.
• MRI with contrast: The definitive test. It shows the size of the tumour in millimetres and how close it lies to the brainstem.
• Balance tests: Vestibular testing is sometimes used to document how much balance function remains before treatment.
• Serial MRI: Repeat scans, usually at 6 months and then yearly, measure growth and guide the decision to treat.

Treatment options

• Active monitoring: Small tumours with little or no growth are scanned regularly. Many never need treatment.
• Stereotactic radiosurgery: A single focused radiation session (Gamma Knife or similar) stops growth in most small and medium tumours. The tumour stays in place and hearing may still decline over years.
• Microsurgical removal: Preferred for large tumours pressing on the brainstem, and for some younger patients. The approach is chosen according to tumour size and whether useful hearing remains.
• Hearing and balance rehabilitation: Hearing aids, bone conduction devices, occasionally a cochlear implant, and vestibular physiotherapy deal with the symptoms that treatment does not reverse.

When it is urgent

Sudden hearing loss in one ear needs an ENT assessment within days, as early steroid treatment may matter. Severe headache with vomiting, new drowsiness, rapidly worsening unsteadiness or sudden facial weakness need emergency assessment where you live, not a flight.

Travelling to Türkiye for treatment

This is a condition where travel can be reasonable, because treatment is planned and rarely urgent. A visit can cover a review of your MRI series by a skull base team, radiosurgery in a single day with a short stay, or microsurgery with about two weeks in Istanbul. Ask how many of these tumours the team treats each year and what their facial nerve results are. Yearly MRI follow-up continues for a long time and should be arranged at home before you travel.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions