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{{Acoustic neuroma}}
{{Acoustic neuroma}}
{{CMG}}{{AE}}{{Simrat}}
{{CMG}}{{AE}}{{M.B}}{{Sab}}
==Overview==
==Overview==
Symptoms of acoustic neuroma include [[hearing loss]], [[tinnitus]], [[vertigo]], [[unsteadiness]], pressure in the ears, [[headaches]], and facial [[pain]].<ref>{{Cite web | title =NIH Acoustic neuroma symptoms | url =https://www.nlm.nih.gov/medlineplus/ency/article/000778.htm}}</ref>
Chronic gradual unilateral [[hearing impairment]] is the most common complaint present in 95% of the [[Patient|patients]]. Common [[Symptom|symptoms]] include chronic gradual unilateral [[Hearing impairment|hearing loss]], ringing in the [[ear]], [[Disequilibrium]], [[Face|facial]] [[Paresthesia|numbness]], [[Face|facial]] [[pain]], and [[Headache]]. Less common [[Symptom|symptoms]] include [[Face|facial]] [[muscle weakness]], [[Taste alteration|taste disturbances]], [[Xerophthalmia|dryness of the eyes]], sudden [[Tears|lacrimation]], [[Dysarthria|speech problem]], [[Dysphagia|difficulty swallowing]], [[Aspiration (medicine)|aspiration]], [[Dysphonia|hoarseness]], and [[Otalgia|ear pain]].
 
==History and Symptoms==
=== History ===
* Chronic gradual unilateral [[hearing impairment]] is the most common complaint present in 95% of the [[Patient|patients]].
* The [[hearing impairment]] usually occurs in [[Patient|patients]] with longstanding [[disease]] but acoustic neuroma may also present with sudden [[sensorineural hearing loss]].
* Ringing in the [[ear]] [[Tinnitus|(tinnitus)]] is an associated complaint among [[Patient|patients]] with the involvement of [[cochlear nerve]].<ref>{{Cite journal
| author = [[Eric E. Smouha]], [[Michael Yoo]], [[Kristi Mohr]] & [[Raphael P. Davis]]
| title = Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm
| journal = [[The Laryngoscope]]
| volume = 115
| issue = 3
| pages = 450–454
| year = 2005
| month = March
| doi = 10.1097/01.mlg.0000175681.52517.cf
| pmid = 15744156
}}</ref>
* Approximately 50% of [[Patient|patients]] with acoustic neuroma report [[disequilibrium]] and [[sense]] of unsteadiness while [[walking]]. 
 
=== Common Symptoms ===
* Chronic gradual unilateral [[Hearing impairment|hearing loss]]<ref name=":0">{{Cite journal
| author = [[C. Matthies]] & [[M. Samii]]
| title = Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation
| journal = [[Neurosurgery]]
| volume = 40
| issue = 1
| pages = 1–9
| year = 1997
| month = January
| pmid = 8971818
}}</ref><ref name="HartDavenport1981">{{cite journal|last1=Hart|first1=Robert G.|last2=Davenport|first2=John|title=Diagnosis of Acoustic Neuroma|journal=Neurosurgery|volume=9|issue=4|year=1981|pages=450–463|issn=0148-396X|doi=10.1227/00006123-198110000-00021}}</ref><ref name=":1">{{Cite journal
| author = [[Xiang Huang]], [[Jian Xu]], [[Ming Xu]], [[Liang-Fu Zhou]], [[Rong Zhang]], [[Liqin Lang]], [[Qiwu Xu]], [[Ping Zhong]], [[Mingyu Chen]], [[Ying Wang]] & [[Zhenyu Zhang]]
| title = Clinical features of intracranial vestibular schwannomas
| journal = [[Oncology letters]]
| volume = 5
| issue = 1
| pages = 57–62
| year = 2013
| month = January
| doi = 10.3892/ol.2012.1011
| pmid = 23255894
}}</ref><ref name=":2">{{Cite journal
| author = [[Robert W. Foley]], [[Shahram Shirazi]], [[Robert M. Maweni]], [[Kay Walsh]], [[Rory McConn Walsh]], [[Mohsen Javadpour]] & [[Daniel Rawluk]]
| title = Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis
| journal = [[Cureus]]
| volume = 9
| issue = 11
| pages = e1846
| year = 2017
| month = November
| doi = 10.7759/cureus.1846
| pmid = 29348989
}}</ref><ref name=":3">{{Cite journal
| author = [[L. R. Lustig]], [[S. Rifkin]], [[R. K. Jackler]] & [[L. H. Pitts]]
| title = Acoustic neuromas presenting with normal or symmetrical hearing: factors associated with diagnosis and outcome
| journal = [[The American journal of otology]]
| volume = 19
| issue = 2
| pages = 212–218
| year = 1998
| month = March
| pmid = 9520059
}}</ref>
* Ringing in the [[ear]]
* [[Disequilibrium]]
* Facial [[Paresthesia|numbness]]
* Facial [[pain]]
* [[Headache]]
 
=== Less Common Symptoms ===
* Facial [[muscle weakness]]<ref name=":0" /><ref name="HartDavenport1981" /><ref name=":1" /><ref name=":2" /><ref name=":3" />
* [[Taste alteration|Taste disturbances]]
* Dryness of the [[Eye|eyes]]
* Sudden [[Tears|lacrimation]]
* Dryness of [[mouth]]
* [[Speech]] problem
* [[Dysphagia|Difficulty swallowing]]
* [[Aspiration (medicine)|Aspiration]]
* [[Dysphonia|Hoarseness]]
* [[Otalgia|Ear pain]]
The below table summarize information about the frequency of major [[Symptom|symptoms]] and [[Medical sign|signs]] of acoustic neuroma:<ref>{{Cite journal
| author = [[C. Matthies]] & [[M. Samii]]
| title = Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation
| journal = [[Neurosurgery]]
| volume = 40
| issue = 1
| pages = 1–9
| year = 1997
| month = January
| pmid = 8971818
}}</ref><ref name="HartDavenport1981">{{cite journal|last1=Hart|first1=Robert G.|last2=Davenport|first2=John|title=Diagnosis of Acoustic Neuroma|journal=Neurosurgery|volume=9|issue=4|year=1981|pages=450–463|issn=0148-396X|doi=10.1227/00006123-198110000-00021}}</ref><ref>{{Cite journal
| author = [[Xiang Huang]], [[Jian Xu]], [[Ming Xu]], [[Liang-Fu Zhou]], [[Rong Zhang]], [[Liqin Lang]], [[Qiwu Xu]], [[Ping Zhong]], [[Mingyu Chen]], [[Ying Wang]] & [[Zhenyu Zhang]]
| title = Clinical features of intracranial vestibular schwannomas
| journal = [[Oncology letters]]
| volume = 5
| issue = 1
| pages = 57–62
| year = 2013
| month = January
| doi = 10.3892/ol.2012.1011
| pmid = 23255894
}}</ref><ref>{{Cite journal
| author = [[Robert W. Foley]], [[Shahram Shirazi]], [[Robert M. Maweni]], [[Kay Walsh]], [[Rory McConn Walsh]], [[Mohsen Javadpour]] & [[Daniel Rawluk]]
| title = Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis
| journal = [[Cureus]]
| volume = 9
| issue = 11
| pages = e1846
| year = 2017
| month = November
| doi = 10.7759/cureus.1846
| pmid = 29348989
}}</ref><ref>{{Cite journal
| author = [[L. R. Lustig]], [[S. Rifkin]], [[R. K. Jackler]] & [[L. H. Pitts]]
| title = Acoustic neuromas presenting with normal or symmetrical hearing: factors associated with diagnosis and outcome
| journal = [[The American journal of otology]]
| volume = 19
| issue = 2
| pages = 212–218
| year = 1998
| month = March
| pmid = 9520059
}}</ref>
 
{| style="border: 3px; font-size 60%; margin: 1px; width: 700px;"
! colspan="4" style="background: #191970; " |
|-
! colspan="2" style="background: #191970; " | {{fontcolor|#FFF|Major signs and symptoms}}
! colspan="2" style="background: #191970; width: 250px;" | {{fontcolor|#FFF|Diagnostic accuracy of clinical features in predicting the tumor progress}}
|-
! style="background: #191970; " | {{fontcolor|#FFF|Signs and symptoms}}
! style="background: #191970; " | {{fontcolor|#FFF|Frequency}}
! style="background: #191970; " | {{fontcolor|#FFF|Sensitivity}}
! style="background: #191970; " | {{fontcolor|#FFF|Specificity}}
|-
! style="padding: 4px 4px; background: #dcdcdc; " | Hypoacusis ([[hearing impairment]])
! style="padding: 4px 4px; background: #6495ED; " | The most common
! style="padding: 4px 4px; background: #6495ED; " | High
! style="padding: 4px 4px; background: #ADD8E6; " | low
|-
! style="padding: 4px 4px; background: #dcdcdc; " | Facial paresthesia
! rowspan="3" style="padding: 4px 4px; background: #6495ED; " | Commonly seen
! rowspan="3" style="padding: 4px 4px; background: #6495ED; " | Moderate
! rowspan="3" style="padding: 4px 4px; background: #87ceeb; " | Moderate
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Gait abnormality|Instability of gait]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Tinnitus]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Hearing impairment|Hearing loss]] (deafness)
! rowspan="5" style="padding: 4px 4px; background: #87ceeb; " | Occasionally seen
! rowspan="5" style="padding: 5px 4px; background: #87ceeb; " | low
! rowspan="5" style="padding: 4px 4px; background: #6495ED; " | high
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Headache]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Facial nerve paralysis|Facial paralysis]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Vertigo]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | Absent corneal reflex
|-
! style="padding: 4px 4px; background: #dcdcdc; " | Bucking
! rowspan="10" style="padding: 4px 4px; background: #ADD8E6; " | Rarely seen
! rowspan="10" style="padding: 4px 4px; background: #ADD8E6; " | Very low
! rowspan="10" style="padding: 4px 4px; background: #6495ED; " | Very high
|-
! style="padding: 4px 4px; background: #dcdcdc; " | Visual disorder
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Nausea and vomiting]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Nystagmus]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Movement disorder]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | Mastication disorder
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Romberg's test|Romberg sign]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Dysphonia|Hoarseness]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Cranial nerves|Abduction disorder]]
|-
! style="padding: 4px 4px; background: #dcdcdc; " | [[Otalgia|Ear pain]]
|}


==Symptoms==
The symptoms vary based on the size and location of the [[tumor]]. Because the tumor grows so slowly, symptoms most often start after age 30.
The typical presentation is with adult onset [[sensorineural]] [[hearing loss]] or [[tinnitus]]. In some patients this goes unnoticed and presentation is delayed until the [[lesion]] is much larger and presents with mass effect. Possibilities include [[cerebellar]] and [[brainstem]] symptoms (e.g. other cranial nerve dysfunction), or [[hydrocephalus]] due to effacement of the fourth [[ventricle]].<ref>{{Cite web | title =Radiopedia Acoustic neuroma clinical presentation  | url =http://radiopaedia.org/articles/acoustic-schwannoma}}</ref>
:*Common symptoms include:<ref>{{Cite web | title =NIH Acoustic neuroma symptoms | url =https://www.nlm.nih.gov/medlineplus/ency/article/000778.htm}}</ref>
:**'''Hearing loss''': Acoustic neuromas typically cause [[sensorineural hearing loss]], meaning there is damage to the inner ear (cochlea) or nerve pathways from the inner ear to the [[brain]]. It involves a reduction in sound level, speech understanding and hearing clarity. The most common first symptom is hearing loss in the affected ear, which often goes unrecognized or is mistaken for a normal change of aging. Hearing loss is usually gradual, although in some cases sudden  hearing loss can occur, and occur on only one side or more pronounced on one side. Hearing loss may be accompanied by ringing in the ears, a condition known as [[tinnitus]], or by a feeling of fullness in the affected ear.
:**'''Abnormal feeling of movement(vertigo)'''
:**'''Tinnitus''': Tinnitus is the perception of sound in the ears or head where no external source is present. Some call it "ringing in the ears" or "head noise". This very common condition affects 1 in 5 people and has no cure. Not all patients with tinnitus have acoustic neuroma and not all acoustic neuroma patients have tinnitus. Tinnitus is present in the affected [[ear]].
:*Less common symptoms include:<ref>{{Cite web | title =Wikipedia Acoustic neuroma symptoms | url =https://en.wikipedia.org/wiki/Vestibular_schwannoma}}</ref>
:**'''Unsteadiness''': Essentially everyone who has been treated for an acoustic neuroma experiences difficulty with balance and/or [[dizziness]] to some degree. For some, this instability may be mild and noticeable only in certain circumstances, such as ambulating with head movements, or walking in the dark. For others, there may be difficulty returning to work, or even performing regular daily activities such as driving, shopping, house work and even working on your computer. Perception of stability is the result of a complex [[brain]] function that uses three systems to inform the brain how the body is oriented in space and how it is moving in relation to its surroundings. Acoustic neuromas can also cause [[dizziness]] and problems with balance such as [[unsteadiness]]. In rare cases, dizziness or balance problems may occur before noticeable hearing loss.
:**'''Pressure in the ears''': Acoustic neuroma patients sometimes complain of a feeling that their ear is plugged or "full".
:**'''Headaches''': Head pain is expected in most patients immediately after acoustic neuroma [[surgery]] (acute phase) because of the incision, variations in cerebrospinal fluid pressure, muscle pain, or even meningitic [[pain]]. It typically responds to appropriate medications and resolves within several weeks. Headache that persists for months or even years after surgery (chronic phase) can be debilitating, and may be an under-appreciated [[complication]] of acoustic neuroma treatment. In patients who experience chronic headaches, the pain often persists for prolonged periods of time, and does not always respond well to various [[medical]] and [[surgical]] treatments. The exact [[prevalence]] and causes of [[chronic]] postoperative headache (POH) are elusive. After surgical treatment of acoustic neuroma, the reported [[incidence]] of headache in the 2012 Acoustic Neuroma Association patient survey has ranged from 0% to 35% depending on the type of surgical approach, technique used and reporting interval since surgery. Frequent and severe POHs have been more often associated with the sub-occipital or retrosigmoid approaches than the translabyrinthine or middle fossa approaches. In some rare cases headaches may be the first sign of an acoustic neuroma.
:**'''Facial pain''': Although rare, complications resulting from the involvement of  cranial nerves include [[facial weakness]] or [[paralysis]], facial [[numbness]] or [[tingling]], and swallowing difficulties. Facial numbness or tingling can be constant or it may be intermittent. In the 2012 Acoustic Neuroma Association patient survey, 29% of the respondents reported facial weakness or paralysis, some of which were pre- and some were post-treatment. This represents a significant improvement from the 1998 Acoustic Neuroma Association patient survey of post-treatment acoustic neuroma patients, which revealed that at the time they completed the survey, only 59% were satisfied with the appearance of their [[face]].
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 15:46, 26 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mohsen Basiri M.D.Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

Chronic gradual unilateral hearing impairment is the most common complaint present in 95% of the patients. Common symptoms include chronic gradual unilateral hearing loss, ringing in the ear, Disequilibrium, facial numbness, facial pain, and Headache. Less common symptoms include facial muscle weakness, taste disturbances, dryness of the eyes, sudden lacrimation, speech problem, difficulty swallowing, aspiration, hoarseness, and ear pain.

History and Symptoms

History

Common Symptoms

Less Common Symptoms

The below table summarize information about the frequency of major symptoms and signs of acoustic neuroma:[7][3][8][9][10]

Major signs and symptoms Diagnostic accuracy of clinical features in predicting the tumor progress
Signs and symptoms Frequency Sensitivity Specificity
Hypoacusis (hearing impairment) The most common High low
Facial paresthesia Commonly seen Moderate Moderate
Instability of gait
Tinnitus
Hearing loss (deafness) Occasionally seen low high
Headache
Facial paralysis
Vertigo
Absent corneal reflex
Bucking Rarely seen Very low Very high
Visual disorder
Nausea and vomiting
Nystagmus
Movement disorder
Mastication disorder
Romberg sign
Hoarseness
Abduction disorder
Ear pain

References

  1. ↑ Eric E. Smouha, Michael Yoo, Kristi Mohr & Raphael P. Davis (2005). "Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm". The Laryngoscope. 115 (3): 450–454. doi:10.1097/01.mlg.0000175681.52517.cf. PMID 15744156. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 C. Matthies & M. Samii (1997). "Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation". Neurosurgery. 40 (1): 1–9. PMID 8971818. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 3.2 Hart, Robert G.; Davenport, John (1981). "Diagnosis of Acoustic Neuroma". Neurosurgery. 9 (4): 450–463. doi:10.1227/00006123-198110000-00021. ISSN 0148-396X.
  4. ↑ 4.0 4.1 Xiang Huang, Jian Xu, Ming Xu, Liang-Fu Zhou, Rong Zhang, Liqin Lang, Qiwu Xu, Ping Zhong, Mingyu Chen, Ying Wang & Zhenyu Zhang (2013). "Clinical features of intracranial vestibular schwannomas". Oncology letters. 5 (1): 57–62. doi:10.3892/ol.2012.1011. PMID 23255894. Unknown parameter |month= ignored (help)
  5. ↑ 5.0 5.1 Robert W. Foley, Shahram Shirazi, Robert M. Maweni, Kay Walsh, Rory McConn Walsh, Mohsen Javadpour & Daniel Rawluk (2017). "Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis". Cureus. 9 (11): e1846. doi:10.7759/cureus.1846. PMID 29348989. Unknown parameter |month= ignored (help)
  6. ↑ 6.0 6.1 L. R. Lustig, S. Rifkin, R. K. Jackler & L. H. Pitts (1998). "Acoustic neuromas presenting with normal or symmetrical hearing: factors associated with diagnosis and outcome". The American journal of otology. 19 (2): 212–218. PMID 9520059. Unknown parameter |month= ignored (help)
  7. ↑ C. Matthies & M. Samii (1997). "Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation". Neurosurgery. 40 (1): 1–9. PMID 8971818. Unknown parameter |month= ignored (help)
  8. ↑ Xiang Huang, Jian Xu, Ming Xu, Liang-Fu Zhou, Rong Zhang, Liqin Lang, Qiwu Xu, Ping Zhong, Mingyu Chen, Ying Wang & Zhenyu Zhang (2013). "Clinical features of intracranial vestibular schwannomas". Oncology letters. 5 (1): 57–62. doi:10.3892/ol.2012.1011. PMID 23255894. Unknown parameter |month= ignored (help)
  9. ↑ Robert W. Foley, Shahram Shirazi, Robert M. Maweni, Kay Walsh, Rory McConn Walsh, Mohsen Javadpour & Daniel Rawluk (2017). "Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis". Cureus. 9 (11): e1846. doi:10.7759/cureus.1846. PMID 29348989. Unknown parameter |month= ignored (help)
  10. ↑ L. R. Lustig, S. Rifkin, R. K. Jackler & L. H. Pitts (1998). "Acoustic neuromas presenting with normal or symmetrical hearing: factors associated with diagnosis and outcome". The American journal of otology. 19 (2): 212–218. PMID 9520059. Unknown parameter |month= ignored (help)

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