PREFERRED PRACTICE PATTERNS3
A 21-year-old college student noticed a ringing in her left ear the day after a big sorority party. She initially thought it was an effect of the loud music at the party, but the ringing persisted and got louder. A couple of weeks later she developed a headache that was reduced but not relieved by acetaminophen. She struggled with studying her textbooks and computerized notes, and began to get dizzy whenever she reached down to the floor or quickly turned her head. She had no limitations in cervical range of motion, strength, or posture. MRI revealed a tumor on the vestibulocochlear nerve.
Disorder of the vestibulocochlear nerve (eighth cranial nerve) that carries vestibular and auditory input from the inner ear to the central nervous system
Slow-growing (usually 1–2 mm/yr), benign tumor of the myelin-forming Schwann cells that surround the vestibular portion of the eighth cranial nerve
Tumor most commonly originates from the inferior vestibular branch
Tumor forms in the internal auditory canal and can extend into the cerebellopontine angle
Typically results in a gradual onset of high-frequency sensorineural hearing loss, tinnitus, sense of ear fullness, unsteadiness, dizziness, vertigo
As tumor grows, there may be facial nerve involvement (resulting in facial numbness or weakness), headache, hydrocephalus, incoordination, diplopia, hoarseness, difficulty swallowing, brainstem compression, death
Tumors classified as sporadic, cystic, or neurofibromatosis type II
Magnetic resonance image of a horizontal section through the head at the level of the lower pons and internal auditory meatus. A left acoustic nerve schwannoma with its high intensity is shown in the left cerebellopontine angle (arrow). (From Waxman SG. Clinical Neuroanatomy. 26th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Physical examination normal, unless the cerebellum or brainstem compromised
Imaging studies abnormal
Neurotologic examination abnormal
Thorough and detailed history essential to distinguish acoustic neuroma from other vestibular disorders and central pathology
Patients typically present with complaints of progressive hearing loss and loss of balance worsening gradually over several months
If tumor growth progresses, may present with other cranial nerve (especially V and VII), brainstem, or cerebellar signs and symptoms
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