ENT

Acoustic Neuroma, also known as vestibular schwannoma, is a benign tumour that occurs deep to the inner ear inside the skull. An individual diagnosed with an acoustic neuroma has a number of management options. At Queen Elizabeth Hospital Birmingham's acoustic neuroma clinic patients will have the opportunity to discuss their condition with specialists who can give expert guidance and advice.

What are the symptoms of acoustic neuroma?

Presentation is typically with hearing loss and in some cases also tinnitus in one ear. Other symptoms such as balance disturbance and numbness on one side of the face can occur. In more advanced tumours patients can experience headaches, visual disturbance and problems with control of their movement.

The acoustic neuroma service

Within the Centre for Rare Diseases the clinic provides access for patients to specialists involved in acoustic neuroma management. This includes ENT, Audiology, Neurosurgery and Radiation Oncology. In addition the clinic links to other specialists who can provide advice on auditory rehabilitation including implants, speech and swallowing therapy, physiotherapy, balance therapy and facial palsy treatment. The clinic is run on Wednesday afternoons on the first, third and fifth Wednesdays of the month.

Management

Management of a patient with an acoustic neuroma is individulalised and determined by a number of factors. These include the size of the tumour and the symptoms caused by the tumour. Also the age and fitness of the patient is important and we give great emphasis to the specific desires of patients with regard to their own choice of treatment.

Typically smaller tumour (less than 2 cm) are managed by surveillance and many do not require anything more than regular scans. Those under surveillance whose tumours grow are usually managed by radiotherapy. Patients with larger tumours (more than 3cm) are in the main offered surgery, and those with medium sized tumours have both surgical and radiotherapeutic options discussed with them.

Specific therapies/treatments

At the clinic the various options appropriate for any individual will be discussed in detail. Surveillance involves having regular check MRI scans initially at 6 months following diagnosis and then less frequently in the medium and long term. Some patients remain under QEHB for their imaging; others will have these done closer to home. Patients who are stable are also in some instances managed by their local team with updates communicated to the clinic from local specialists.

Stereotactic radiotherapy at QEHB is delivered using a Cyberknife. Acoustic neuromas are one of the most commonly treated tumours on the QEHB Cyberknife and this remains the only unit outside of London. Treatment is typically delivered in a single outpatient session and also referred to as “radiosurgery”. Treatment is completely non-invasive and further information is available in the patient information leaflet section of the website (see below).

Surgery involves a combined ENT & Neurosurgeon team and usually takes 6 to 8 hours. Following surgery patients remain in hospital for up to a week and take a number of weeks to fully recover.

The clinic also provides access to specialists for advice on the management of the symptoms caused by the tumour and the rehabilitation of any complications arising from treatment. These include balance, hearing and facial palsy management.

How to contact the service

Tracey Plant, Medical Secretary

• Tracey.Plant@uhb.nhs.uk
• 0121 371 4511