1. THE ACOUSTIC TUMOR
You encounter a person with unilateral
hearing loss. They wish to get a hearing
instrument for the ear because it has always
been their favorite ear to use on the phone.
You choose to not dispense a hearing
instrument to them and make a referral to a
physician for further investigation of the
condition.

2. THE ACOUSTIC TUMOR
The person chooses to obtain a hearing
instrument over the internet because all they
want to do is hear better on the phone.
No professional is willing to dispense a
hearing instrument without recommending a
medical referral.

3. THE ACOUSTIC TUMOR
The person notices the left portion of their
face is beginning to “tingle” and feel numb,
They believe the numbness is probably from
the headaches resulting from long hours at
work—their poor vision from long hours on
the computer.

4. THE ACOUSTIC TUMOR
Over the winter, the person slips on the icy
sidewalk, falls, and breaks a hip and becomes
bedfast for several weeks following the
surgery.
The physical therapy is not responding well as
an ataxic gait has developed.

5. THE ACOUSTIC TUMOR
The person discontinues use of the hearing
instrument because they really only needed it
for the phone at work and are now unable to
work.
The post surgery medications and over the
counter meds all seem to create nausea and
occasional vomiting.

6. THE ACOUSTIC TUMOR
The person believes the fall has disabled them
from much physical activity; and choose to
spend most of their time at home or in bed.
A few years later, they are pronounced dead
due to respiratory failure.

7. THE ACOUSTIC TUMOR
Further investigation of the cause of death
reveals a large acoustic neuroma in cerebella
pontine area—behind the temporal bone.
Hearing loss is a symptom---not a disease!

8. THE ACOUSTIC TUMOR
Acoustic neuromas account for about eight
percent of all primary intracranial tumors and
about ninety percent of all tumors located in
the cerebellopontine angle.

9. THE ACOUSTIC TUMOR
 Tumor Characteristics
A tumor is commonly referred to as a
neoplastic growth.
It is an abnormal persistent tissue mass which
may be either in a benign or malignant form.
Malignant tumors grow more rapidly and
benign tumors grow more slowly.

10. THE ACOUSTIC TUMOR
 Tumor Characteristics
In general, most acoustic neuromas are
benign, slow-growing neoplasms.
They usually take the path of least resistance
and grow from the internal auditory canal
area of the temporal bone back into the
cerebellopontine angle.
It will eventually compress the brainstem and
cerebellum.

11. THE ACOUSTIC TUMOR
 Tumor Characteristics
About seventy-five percent of the tumors grow
less than 0.2 cm/year.
Of course, the other twenty-five percent grow
at a greater rate.

12. THE ACOUSTIC TUMOR
 Tumor Characteristics
There are commonly three stages of growth
which will manifest various physical
conditions. They are:
1. The internal auditory canal stage
2. The early cerebellopontine angle stage
3. The late cerebellopontine angle stage

13. THE ACOUSTIC TUMOR
The most common physical symptom is a
complaint of unilateral hearing loss and
tinnitus.
A reported observation of poor understanding
over the telephone with use of the affected ear
is also often reported.

14. THE ACOUSTIC TUMOR
Other symptoms observed/reported may be a
slow corneal reflex, facial numbness, and
asymmetrical eye blink (one eye will blink
more slowly than the other).

15. THE ACOUSTIC TUMOR
 Tumor Assessment/Diagnosis
Any asymmetrical sensorineural hearing loss
with unusually poor word recognition (as
revealed through audiometry) should be
considered suspicious and referred for further
medical analysis.

16. THE ACOUSTIC TUMOR
 Tumor Assessment/Diagnosis
No single auditory test is precise enough to be
a perfect site-of-lesion indicator.
Tumor size will even effect the validity of
auditory brainstem tests.
However, if abnormal ABR results are
revealed, there is over a ninety percent chance
that there is a retro-cochlear lesion present.

17. THE ACOUSTIC TUMOR
 Tumor Assessment/Diagnosis
There are other tests available to assist with
determining acoustic neuroma presence and
site-of-lesion. They are:
 Vestibular testing—specifically calorics
 Radiologic imaging—specifically MRI
w/contrast (can “see” tumors as small as
2mm)

18. THE ACOUSTIC TUMOR
 Acoustic Neuroma Management
As with any medical challenge, early detection
of lesion will result in its most effective
management. Four management protocols
are normally implemented. They are:
1. Hearing preservation surgery
2. Destructive surgery
3. Stereotactic radiotherapy (gamma knife)
4. “Waitful observation”

19. THE ACOUSTIC TUMOR
 Hearing Preservation Surgery
When the acoustic neuroma is small (detected
early), current surgical procedures can
remove the tumor without destroying the
remaining hearing within that ear.

20. THE ACOUSTIC TUMOR
 Destructive Surgery
A large of “fast-growing” acoustic neuroma
may require this procedure. It will destroy
any remaining hearing within the ear but,
further life-threatening complications will be
ameliorated.
These tumors are often larger than two
centimeters.

21. THE ACOUSTIC TUMOR
 Stereotactic Radiotherapy
The “gamma knife” is used when the surgeon
believes there may be too many bleeding or
neural issues present thus contraindicating an
invasive surgical procedure.

22. THE ACOUSTIC TUMOR
 “Waitful Observation”
Given that seventy-five percent of acoustic
neuromas are benign (slow-growth), this is a
common recommendation for elderly patients
with an acoustic neuroma.
Note: The death rate from surgical
complications has been reduced from 3.7
percent in 1960, to about 0.5 percent today.

23. THE ACOUSTIC TUMOR
 Case Reports
Let’s review the three case reports found
on pages #220--#224.

24. THE ACOUSTIC TUMOR
Every patient/client with unexplained
asymmetrical, unilateral sensorineural
hearing loss, facial nerve problem, or
dizziness episodes should be considered
to have an acoustic tumor until proven
otherwise!