AN Symptoms:
Symptomatic Progression and Individual Histories

This article, contributed by Dick Barker, appeared in the September 98 issue of the ANA/NJ newsletter.  ANA/NJ has submitted it to the American Academy of Family Physicians for publication, with the goal of increasing awareness of acoustic neuroma symptoms among professionals as well as the general public.


Small
(<1.0cm)
Hearing loss in one ear
Fullness feeling in ear
Unilateral tinnitus
Vertigo, Balance problems
Medium
(1.0-2.5cm)
Hearing loss worsens
Balance problems worsen
Disequilibrium
Large
(2.5-4.0cm)
Facial tingling, numbness
Occasional headaches
Facial Pain
Frequent disequilibrium
Giant
(>4.0cm)
Visual loss
Persistent headache

Table [on the right] shows symptoms that are likely to occur at various stages in the development of an acoustic neuroma. How useful are such general guidelines for diagnosing AN? We asked several ANA/NJ members who had long periods of symptoms to provide information about their individual pre-diagnosis experience. What they have reported is interesting to compare with the guidelines in the table.

* David B (age 55 at diagnosis) had the longest period of AN symptoms: 30 years! His beginning symptoms were a reduction of hearing and tinnitus in one ear. Hearing deteriorated gradually over 25 years until, five years before diagnosis, it was down 80%. Specialists told him that the most likely cause was nerve damage due to his hunting. Also at five years before diagnosis, occasional (2-3/month) but not severe headaches of 3-4 hours duration began. The headaches and hearing loss were the two symptoms present in June 1997 when a new doctor ordered a CT scan and then an MRI. The diagnosis was a 2.0x3.0 cm acoustic neuroma pressing on the brain stem. The tumor was said to be not "typical" because it was not in the canal, but it did encase the eighth nerve.

* A very gradual hearing loss in the right ear was the only problem Jack S experienced for 10 years before an MRI revealed a 2.0 cm AN. There was no tinnitus, no noticeable imbalance. Jack was also age 55 when diagnosed.

* For three years before her diagnosis at age 53, Alice L experienced a wider range of symptoms, as well as some extra problems. Initial symptoms that sent her to two different doctors were reduction of hearing in the left ear, earache, imbalance and extreme fatigue. A problem with the eustachian tube was diagnosed by both doctors. A herniated disc in the neck then complicated matters, but when the doctor who treated this was told of the hearing loss, he immediately sent Alice to an ENT. By this time, on the verge of MRI and diagnosis, additional symptoms were disequilibrium (two bad falls) and facial numbness and pain. The MRI revealed a 2+ cm acoustic neuroma pressing on the brain stem.

* Audrey G’s symptoms over three years before diagnosis at age 38 were less distressing: mainly, a gradual loss of hearing , followed after two years annoying facial numbness. Imbalance was also a symptom of this 2.4 cm tumor, although Audrey’s doctor had to convince her of this by testing.

* Dolores S’s earliest and most distressing symptom in her five years before diagnosis was severe imbalance, which reminds us that ANs are most accurately called vestibular schwannomas. Dolores also experienced a fullness feeling and loss of hearing in the right ear. At diagnosis (at age 64), the 1.5 cm tumor was pressing on the brain stem.

* Wendy C had AN symptoms for 5 years before diagnosis. First came a complete hearing loss in the left ear, with spontaneous recovery after one week, but gradual hearing deterioration thereafter. Vertigo and nausea were also early problems. Then tinnitus began in the left ear. Wendy adds that she had experienced severe headaches since her twenties, and these continued during the five years before MRI and diagnosis at age 48. Except for headaches, all these symptoms appear to identify with a small AN, but the MRI showed a 2.0 cm tumor. Her doctor said that the tumor must have been growing for 5-10 years.

* Sharon K (age 23 at diagnosis) reported on her symptoms over eight years for the smallest tumor (3 mm) recorded in our Registry. The symptoms were "typical" for a small AN: gradual deafness and tinnitus in the left ear. The hearing loss started first, while ringing in the ear began about two years later. There were no other symptoms before an MRI revealed the 3 mm tumor. The surprise was that in surgery the diagnosed AN turned out to be a small hemangioma. This benign blood vessel tumor was of the type that could not be safely removed. The surgeons made room for it to grow and left it to be monitored yearly with MRIs. Because of Sharon’s case, we learned of two other hemangiomas that were discovered in surgery. One was removed successfully, while the second was found to be concealing a small AN that could be removed.

To conclude: general guidelines for acoustic neuroma symptoms are helpful, but clearly allowance must be made for great variability, and the unsuspected. The tumor’s position and/or shape may be as important as its size. As stated in the ANA booklet on Acoustic Neuroma (1987): "There is not a typical pattern of symptoms caused by a developing acoustic neuroma, thus making early diagnosis a challenge."

Acoustic Neuroma Association, New Jersey Chapter
September 1998


Last Edited: Friday, November 01, 2002