At a glance
What it is
A benign tumour arising from Schwann cells on the vestibular (balance) nerve; also called vestibular schwannoma.
Typical signs
One-sided hearing loss, tinnitus, unsteadiness — signs are progressive, not sudden.
How we treat it
Three options: observation with serial MRI, focused radiosurgery, or microsurgical removal.
What acoustic neuroma is
Acoustic neuroma is a rare non-cancerous tumour. It grows slowly from an overproduction of Schwann cells on the balance and hearing nerve as it leaves the brainstem. Schwann cells normally wrap around and support nerve fibres — when they multiply out of control, they form a mass that presses on nearby structures.
A small tumour affects only the balance nerve. A larger one can compress the facial nerve, the brainstem, or the fourth ventricle. The clinical picture reflects what the tumour is pressing on, not simply its size.
Two forms of acoustic neuroma
The distinction matters because unilateral and bilateral tumours behave differently — different age of onset, different genetic basis, different treatment planning.
Form A
Unilateral acoustic neuroma
- Affects one ear only; the most common form.
- Presents between 30 and 60 years of age.
- No inherited pattern; cause is usually unknown.
Form B
Bilateral acoustic neuroma
- Affects both ears; inherited.
- Caused by neurofibromatosis type 2 (NF2).
- Presents earlier — often in the teens or twenties.
How it is diagnosed
Diagnosis is confirmed by an MRI of the internal auditory canals with contrast. This is ordered whenever hearing loss is asymmetric — the scan finds tumours as small as a few millimetres. Audiometry (a formal hearing test) is used both at diagnosis and to track the ear over time.
When a tumour is found, it is measured precisely and its relationship to the brainstem and facial nerve is mapped. This defines the treatment options and the risk of each.
Very small acoustic neuromas do not need treatment. They need to be watched. A patient can be needlessly harmed by treating a tumour that would have stayed quiet on its own.
How it is treated
The three treatment options are complementary, not competing. Which is right for a given patient depends on tumour size, growth rate, symptoms, age, and hearing status.
Observation
Small, stable, minimally symptomatic tumours
- Serial MRI at intervals (6, 12, then 24 months)
- Annual audiometry to track hearing
- Escalate to active treatment only if the tumour grows or symptoms worsen
Radiosurgery
Focused radiation for medium tumours
- Gamma knife or linear accelerator
- Single or fractionated dose
- No incision; day-case
- Aim: arrest growth, preserve hearing where possible
Microsurgery
Larger tumours, or when observation/radiosurgery fails
- Suboccipital, translabyrinthine, or middle fossa approach
- Intra-operative facial nerve monitoring throughout
- Hospital stay of 5–10 days depending on approach
- Follow-up MRI at 6 and 12 months, then annually
The choice is always discussed with the patient in detail. Nobody with an acoustic neuroma leaves the clinic without a written plan they understand.
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This page provides general information about acoustic neuroma and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.