An acoustic neuroma is a benign tumor of the cranial nerve that connects the inner ear and the brain. Though noncancerous and typically slow growing, it can affect both hearing and balance, and may cause hearing loss, tinnitus and dizziness. In rare cases, tumors may become large enough to press against the brain, interfering with vital processes and even leading to death.
What Causes Acoustic Neuromas?
A small percentage of acoustic neuromas are the result of an inherited disorder called neurofibromatosis type II (NF2), associated with a malfunctioning gene on chromosome 22. This genetic disorder often causes benign tumors to develop on the balance nerves on both sides of the head.
More often than not, acoustic neuromas are classified as sporadic, meaning their exact cause is unknown. There is some evidence of a connection between exposure to low-dose radiation of the head and neck during childhood and the development of acoustic neuromas.
There are no known risk factors for acoustic neuromas other than having a parent with NF2. If this is the case, children have a 50 percent chance of inheriting the condition themselves.
What Are the Symptoms of Acoustic Neuromas?
Acoustic neuromas, sometimes called vestibular schwannomas, usually grow very slowly (or not at all). Because of this, symptoms early on are often difficult to spot. You may notice gradual hearing loss that is sometimes accompanied by tinnitus.
If the tumor continues to grow, additional symptoms are likely to develop. These include dizziness and vertigo, facial numbness and weakness, a tingling sensation in the face, changes in taste, hoarseness, difficulty swallowing, headaches and confusion. Early diagnosis and treatment can help prevent more serious symptoms.
How Are Acoustic Neuromas Treated?
Your otolaryngologist can diagnose an acoustic neuroma primarily through a review of your symptoms in conjunction with a hearing test and imaging scans (CT or MRI). Because growth of the tumor is usually very slow, many times your doctor will simply want to monitor the tumor’s progress over time, especially when few symptoms are present. Regular imaging tests every six to 12 months can track any growth.
Surgery may be an option for tumors that are growing or causing symptoms. Gamma Knife radiosurgery delivers radiation without the need for an incision, but results can take a long time. More invasive surgery may be required, especially if your tumor is growing close to the brain or facial nerve.
In addition to pain and discomfort, a middle ear infection can cause tiny air cells in the mastoid bone to fill up with pus. As the infection spreads, potentially reaching the brain, the bone is destroyed, resulting in hearing loss. If antibiotics are unsuccessful in clearing up the infection, then mastoid surgery may be needed.
Mastoiditis Causes & Symptoms
The medical term for infection of the mastoid cells is mastoiditis. The condition affects children more often than adults since they are most prone to middle ear infections, but can strike adults on occasion. Bacteria migrate from the middle ear to the air cells of the mastoid bone, which are essential for proper drainage of fluid. Cholesteatoma, a type of skin cyst, can also prevent the ear from draining properly leading to mastoiditis.
Symptoms of mastoiditis include swelling, redness, and tenderness of the ear lobe and area behind the ear as well as drainage of fluids from the ear, fever, irritability and lethargy.
Mastoiditis Diagnosis & Treatment
Mastoiditis can cause serious – even life-threatening – health complications if untreated, so proper diagnosis is a crucial first step toward recovery. Our doctor will examine your ears with an otoscope, looking for signs of infection. Diagnostic tests such as a CT scan or MRI may be administered to help rule out other conditions.
Many cases of mastoiditis are treated successfully with antibiotics. Chronic cases may require frequent visits for thorough ear cleanings. When antibiotics fail to treat the problem adequately, or it recurs frequently, surgery may be necessary.
Mastoid surgery, or mastoidectomy, involves drilling a hole in the mastoid bone and removing the infected air cells. This procedure is performed under general anesthesia, and many patients return home later the same day.
Afterwards, your ears will be bandaged, and there may be stitches. You might experience headaches, discomfort and numbness. You’ll likely be prescribed pain medication and antibiotics, and will need to return after a few days to have your bandages and stitches removed. You’ll need to keep your ear free of water, and avoid strenuous activity or anything that might create pressure on your ear (e.g. airplane travel).
Complications are rare, but might include facial nerve paralysis, sensorineural hearing loss, vertigo, tinnitus, and a change in taste.
Cholesteatoma is an abnormal skin growth in the middle ear behind the eardrum that may also affect the mastoid (skull bone). It begins as a cyst that gradually increases in size, destroying the bones of the middle ear and causing hearing loss.
What Causes Cholesteatoma?
When the Eustachian tube is functioning normally, it equalizes ear pressure by moving air from the back of the throat into the middle ear. Allergies and viruses can affect performance, leading to a partial vacuum in the ear.
This negative pressure stretches the eardrum, creating a pocket or cyst that fills with old skin cells and waste material, which can become easily infected. In rare cases, cholesteatoma can be congenital (present at birth).
What Are the Symptoms of Cholesteatoma?
Symptoms of cholesteatoma include drainage from the ear, a feeling of fullness, hearing loss, earache and dizziness. Since these are also present in other conditions, tests such as CT scans and electronystagmography can be used to rule out other conditions and confirm the diagnosis. Cholesteatomas continue to grow if not treated and can lead to complications such as:
- Facial paralysis.
- Brain abscess.
How Is Cholesteatoma Treated?
An otolaryngologist will determine the size and growth rate of the cholesteatoma and recommend treatment based on these findings. Controlling the infection with antibiotics or eardrops is a crucial first step.
If you have a large cholesteatoma it may be treated surgically. Performed under general anesthesia on an outpatient basis, the cholesteatoma is removed in order to eliminate the infection. Follow-up surgery to ensure the cholesteatoma is gone and to reconstruct damaged middle ear bones may be necessary.
Otosclerosis is an abnormal growth of bone in the middle ear that causes hearing loss. It typically begins in the early 20s, and is the leading cause of middle ear hearing loss in young adults.
What Causes Otosclerosis?
The exact cause of otosclerosis is not known, but evidence suggests a genetic link passed down from parent to child. Middle-aged Caucasian women are most at risk, and hormonal changes seem to be a contributing factor including pregnancy and menopause. This bone growth usually occurs around the stapes bone in the middle ear, preventing it from moving freely, essential to proper hearing.
What Are the Symptoms of Otosclerosis?
Gradually worsening hearing loss is the primary symptom of otosclerosis. It may begin with an inability to hear low-pitched sounds or whispers. Other symptoms may include vertigo or dizziness and tinnitus (ringing in the ears).
How is Otosclerosis Treated?
The symptoms of otosclerosis are like those of other conditions, so a thorough examination by an otolaryngologist is essential in ruling out other problems and diagnosing the disease. A hearing test will usually show signs of conductive hearing loss in the lower frequency tones, a hallmark of otosclerosis.
Mild cases of otosclerosis can be corrected with a hearing aid designed to amplify sounds. Orally ingested sodium fluoride has been shown to slow the progression of the disease, and may be an option.
In more advanced cases, a surgical procedure known as a stapedectomy is often performed. In this surgery, part or all of the affected stapes bone is removed and replaced with a prosthetic device that enables the bones of the middle ear to resume movement, allowing sound waves to reach the inner ear, improving or restoring hearing.
There are inherent risks in any surgery, but left untreated, otosclerosis will only get worse. Speak to your doctor about the best treatment options for your hearing loss.