Sudden severe headache with vomiting, drowsiness or unsteadiness needs emergency care today. A large tumour can obstruct the flow of fluid around the brain. Also seek urgent care for sudden complete hearing loss on one side.
A benign tumour growing on the nerve of balance beside the hearing nerve, between the inner ear and the brainstem. It grows slowly, and how it is treated depends more on its size and your hearing than on the tumour itself.
One-sided hearing loss or ringing should always prompt an MRI. It is very often something benign, but this is the tumour it exists to exclude, and finding it small changes what is possible.
Despite the name, it arises from the vestibular nerve, which carries balance information, rather than the hearing nerve — which is why the correct term is vestibular schwannoma. It grows in the narrow canal between the inner ear and the brainstem, and as it enlarges it presses on the hearing nerve, then on the facial nerve, then on the brainstem and cerebellum.
It is benign and does not spread. Growth is typically slow — many enlarge by only a millimetre or two a year, and a proportion do not grow at all over years of observation.
The facial nerve runs directly alongside the tumour, stretched thin across its surface as it enlarges. Preserving that nerve is the central technical challenge of surgery, because facial weakness affects the eye, speech and appearance permanently. This is the single strongest reason to choose a surgical team that does this operation regularly.
Hearing is usually already impaired by the time the tumour is diagnosed, and preserving useful hearing is achievable only in a minority — mainly small tumours in patients whose hearing is still good. That should be discussed honestly before treatment rather than assumed.
Hearing loss that affects one ear considerably more than the other, or one-sided tinnitus, is not the pattern of ordinary age-related hearing loss. It should prompt an MRI of the internal auditory canals, even when a hearing test appears otherwise unremarkable. The great majority turn out to have no tumour, but this is precisely the diagnosis the scan exists to exclude — and small tumours have far more treatment options than large ones.
A dedicated MRI is definitive; hearing tests establish what there is to preserve.
How much useful hearing remains on the affected side materially changes the treatment discussion. If hearing is already lost, preserving it is no longer a consideration and the decision simplifies. If it is still good, hearing preservation becomes a genuine factor in choosing between radiosurgery and surgery. Send the audiogram with the MRI, and any earlier scan so growth can be judged.
For small tumours all three options are reasonable, and the choice depends on your priorities as much as the tumour.
Repeat scanning at intervals with treatment only if the tumour grows. A meaningful proportion of small acoustic neuromas grow very little or not at all, and observation avoids the risks of both surgery and radiation. It requires reliable access to repeat scanning, which is worth considering if that is difficult where you live.
Focused radiation in one or a few sessions, with no incision and usually no hospital stay. It controls growth in the large majority of small and medium tumours with a lower risk of facial weakness than surgery. It does not remove the tumour, and lifelong surveillance scanning continues afterwards.
The tumour is removed through one of several approaches chosen according to its size and whether hearing preservation is being attempted. Continuous facial nerve monitoring is essential. It offers definitive removal and is the only option for large tumours compressing the brainstem, at the cost of a larger operation and greater facial nerve risk.
Balance retraining after surgery is important and frequently neglected — the brain compensates well but needs the right exercises. Where hearing is lost on one side, a CROS aid or a bone-anchored implant can route sound from the deaf side to the hearing ear.
Small tumours have all three options. Large tumours pressing on the brainstem need surgery.
If useful hearing persists, preserving it becomes a real consideration. If it is already lost, the decision is simpler.
Observation demands reliable repeat scanning over years. Where that is difficult, definitive treatment may be the more practical choice.
Ask any surgeon how many acoustic neuromas they operate on each year and what their facial nerve preservation rate is. In this tumour those two numbers matter more than anything else.
A large tumour causing hydrocephalus or brainstem compression needs urgent local assessment. Small tumours allow plenty of time to consider the options properly.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Hearing on the affected side is usually already reduced by the time of diagnosis, and preserving useful hearing is realistically achievable only in a minority — mainly small tumours in patients whose hearing remains good. This should be discussed frankly before treatment. Hearing in the other ear is unaffected, and devices exist to route sound from the deaf side.
The facial nerve runs directly alongside the tumour and is the main risk of surgery. Modern microsurgery with continuous nerve monitoring preserves it in the large majority of small and medium tumours, but risk rises with size. Radiosurgery carries a lower facial nerve risk. Ask any surgeon for their own preservation figures, not published averages.
For a small tumour causing limited symptoms, particularly in an older patient, observation is entirely reasonable and a proportion of these tumours grow very little. It does require reliable repeat MRI over years. If that is difficult to arrange where you live, that practical consideration should form part of the decision.
For tumours up to around three centimetres, radiosurgery controls growth in most patients with a lower risk of facial weakness, but it leaves the tumour in place and requires lifelong scanning. Surgery removes it definitively and is necessary for larger tumours, at the cost of a bigger procedure. Both are legitimate for medium tumours, and your priorities matter.
Because the tumour damages the balance nerve slowly, the brain compensates gradually rather than being suddenly deprived. That produces a persistent sense of imbalance rather than the spinning vertigo of a sudden inner ear problem. Balance retraining exercises after treatment help considerably and are often overlooked.
Bilateral acoustic neuromas indicate neurofibromatosis type 2, a genetic condition that changes management substantially — the priority becomes preserving hearing for as long as possible rather than removing tumours, and other family members should be assessed. Tell us at the outset if both sides are involved.
Send the MRI of the internal auditory canals and your audiogram. How much hearing remains changes the discussion considerably.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.