Acoustic neuromas are benign (noncancerous) tumors that develop on the nerve that connects your inner ear to your brain.

In some cases, an acoustic neuroma doesn’t need immediate treatment and can be monitored by a healthcare professional instead. Other times, doctors might recommend treatment, including surgery and radiation therapy. There are no known home or natural remedies to prevent or treat this condition.

Acoustic neuromas are sometimes referred to as vestibular schwannomas.

Schwannomas are a category of tumors that form on the sheath (protective covering) of nerve cells called Schwann cells, according to the National Cancer Institute. Schwannomas account for about 8 percent of all tumors diagnosed in the skull.

Read on to learn about the potential treatment options for acoustic neuromas and when each one is recommended.

Approximately 3,000 acoustic neuromas are diagnosed in the United States each year.

These tumors are usually benign and not life threatening. Even so, it’s possible that they will need prompt treatment to avoid complications.

Generally speaking, treatment decisions center around several factors, including:

  • the size of the tumor
  • the location of the tumor
  • the rate at which the tumor is growing
  • the level of hearing in your affected ear
  • whether it affects other nerves or tissues in your head
  • your age and overall health
  • your personal preferences

When going over potential treatments, a healthcare professional will let you know the benefits and drawbacks of each option to help you make the best decision for your health.

Here’s how doctors usually approach treatment for acoustic neuromas.

Observation

It’s possible to have a tumor that grows so slowly that it can remain under observation and never require treatment.

A doctor may recommend observation if your acoustic neuroma:

  • is small
  • isn’t getting larger
  • causes no or few symptoms

A healthcare professional will order periodic MRI scans, usually every 6 to 12 months. This allows the doctor to carefully monitor your tumor for signs of growth. If your symptoms worsen or scans show that the tumor is growing, your doctor will discuss other treatment options with you.

A 2018 study of people with small acoustic neuromas found that, after a median follow-up period of 25 months, 15 out of 61 individuals (24.6 percent) switched from observation to another treatment type. Most often, this was because the tumor had grown.

Surgery

In this treatment method, a surgeon will remove all or part of the tumor. You may need surgery for a variety of reasons, such as if a smaller tumor is getting larger or a large tumor is causing significant symptoms.

There are three different surgical approaches for acoustic neuromas, according to a 2017 review. All of these methods involve opening the skull to reach the tumor. Which approach is used will depend on factors like:

  • tumor size
  • tumor location
  • your level of hearing in the affected ear

The three surgical approaches for acoustic neuromas are:

  • Retrosigmoid. In this approach, a surgeon will remove the tumor through an opening made in the area behind the ear. The retrosigmoid approach is generally best for preserving hearing.
  • Middle cranial fossa. In this approach, the surgeon will remove the tumor through an opening made at the side of the head and above the ear. This is another good method for preserving hearing.
  • Translabyrinthine. This approach involves a surgeon removing the tumor through an opening that provides access to the inner ear canal. It’s mostly used for people with limited hearing or total hearing loss in the affected ear.

Generally speaking, smaller tumors are easier to remove and still preserve some hearing function. For these types of tumors, surgical removal typically improves other symptoms as well.

Larger tumors are more complicated because they often impact nearby nerves and tissues. These nerves and tissues may get damaged during removal, which may make some symptoms worse. In this situation, a healthcare professional may recommend only partial removal of the tumor instead of full removal.

Large tumors may also require a combination treatment approach from both a neurosurgeon and a neurotologist.

Radiation therapy

Radiation therapy, or radiosurgery, is a treatment used to shrink the tumor or to reduce its growth, according to 2018 research. It is associated with high rates of hearing preservation.

This treatment method isn’t technically surgery. That’s because it’s noninvasive, which means it doesn’t involve an incision. Plus, most adults don’t require anesthesia with radiation therapy.

A healthcare professional may recommend radiosurgery for small or medium-sized tumors. It is often recommended for people who:

  • are older adults
  • have other health conditions
  • have acoustic neuromas in both ears
  • hear out of only one ear and have an acoustic neuroma in that ear

One main form of radiosurgery is called stereotactic radiosurgery (SRS). Several different technologies or systems exist for performing SRS, including Gamma Knife, CyberKnife, and Triology.

SRS is usually performed by both an otolaryngologist and a radiation oncologist. An otolaryngologist is often referred to as an ENT because they specialize in ear, nose, and throat concerns.

In this treatment for acoustic neuromas, a healthcare professional will use these technologies to deliver radiation to the tumor. The goal is to very precisely target the DNA of tumor cells while avoiding surrounding tissues.

You may need one or multiple sessions of SRS.

Acoustic neuroma risk factors

So far, the only known risk factor for acoustic neuroma is a rare genetic condition called neurofibromatosis type 2 (NF2), according to a 2021 research review. Individuals with this condition often develop acoustic neuromas in both ears at the same time. It is caused by a mutation in the NF2 gene that stops a tumor-suppressing protein from working as it should.

If an acoustic neuroma is small, you may not experience any symptoms. If you do have symptoms, 2021 research suggests they may include the following in the affected ear:

As an acoustic neuroma becomes larger, it can begin to compress other nearby nerves that serve the face, mouth, and throat. This can lead to symptoms like:

Very large acoustic neuromas can disrupt the flow of cerebrospinal fluid (CSF). This can lead to a serious condition called hydrocephalus.

In hydrocephalus, CSF builds up, which increases pressure in the skull. It leads to symptoms like:

It’s important that you contact a healthcare professional at the first sign of symptoms like hearing loss, tinnitus, or vertigo. While your symptoms may not be due to an acoustic neuroma, they could be caused by another condition that needs treatment.

If you do have an acoustic neuroma, early diagnosis and treatment can help improve your outlook. This can prevent potentially serious complications like permanent hearing loss and hydrocephalus.

If you have symptoms of an acoustic neuroma, a healthcare professional will ask you about your medical history and perform a physical evaluation. During this evaluation, they’ll examine your ears and assess your balance.

They will also conduct a hearing exam, known as audiometry. This exam tests your ability to hear various sounds or tones.

A healthcare professional can confirm an acoustic neuroma diagnosis through the use of imaging. Typically, they will order an MRI scan, which can create images of the tumor and show the doctor exactly where it’s located. In certain circumstances, the doctor might request a CT scan instead.

Treatments like surgery and radiation therapy can help prevent potentially serious complications from an acoustic neuroma that’s very large or growing larger. In some cases, symptoms may improve and hearing can be preserved.

These treatments do come with risks, though, which a healthcare professional can explain to you. Potential complications include:

  • hearing loss
  • tinnitus
  • balance concerns
  • nerve damage

Monitoring is important after treatment. If you had radiation therapy, for example, a tumor can begin growing again. That’s why your doctor will want to continue keeping an eye on the tumor through periodic scans.

Some acoustic neuromas won’t need treatment at the time of diagnosis. However, it’s important to monitor your symptoms and the tumor’s status for any changes. Your healthcare professional can guide you in choosing the right treatment option for you.