Vestibular Schwannoma / Acoustic Neuroma

The presentation of a vestibular schwannoma can vary, but common signs and symptoms include:

• Unilateral hearing loss: This is often the first noticeable symptom. It usually comes on gradually. You might find yourself asking people to repeat themselves more in one ear, holding the phone to the other ear, or noticing you can’t hear whispers on one side. High-frequency hearing tends to be affected first.
• Tinnitus: A ringing or buzzing in the affected ear is common. It can be constant or intermittent. Even people with very small tumors often have tinnitus.
• Imbalance or unsteadiness: Unlike inner ear conditions like BPPV or Meniere’s, an acoustic neuroma usually doesn’t cause sudden spinning vertigo. Instead, you may experience a chronic sense of imbalance or veering to one side, especially in low light or when on uneven surfaces. Since the tumor affects the balance nerve slowly, your brain often compensates as it grows, so the imbalance might be subtle – perhaps you just don’t feel quite as confident in your footing, or you have difficulty when you make quick movements.
• Dizziness with quick head movements: Some people with acoustic neuroma notice brief episodes of dizziness when turning quickly or bending over, similar to vestibular hypofunction symptoms, because the affected nerve isn’t transmitting properly.
• Facial numbness or tingling (less common): If the tumor grows large, it can press on the facial nerve (responsible for facial sensation and muscles). In such cases, one might experience mild facial numbness, tingling, or weakness on that side. This is typically in later stages with larger tumors.
• Headaches or pressure (rare, in larger tumors): A very large tumor can increase intracranial pressure slightly, leading to headaches or even hydrocephalus. However, most diagnosed acoustic neuromas are not this large, as they’re caught earlier due to hearing changes.

It’s worth noting that many acoustic neuromas are discovered when they’re still small, during hearing tests or MRI scans following asymmetric hearing loss. At that stage, imbalance might be mild. However, after treatment (surgery or radiation), balance issues can become more pronounced as the tumor’s effect or the treatment damages the vestibular nerve input more definitively.

Dealing with an acoustic neuroma and its treatment can impact your life in several ways:

• Communication challenges: Hearing loss in one ear can make conversations challenging, especially in noisy environments or group settings. You might start to withdraw from social situations like dining out or meetings because it’s exhausting to follow conversations. It can also pose safety issues – for instance, not hearing an approaching car or someone calling out from your deaf side. Many patients experience frustration, and family members may also struggle to adapt (you might need them to walk on your good ear side, for example).
• Occupational effects: Depending on your job, unilateral hearing loss or balance issues can interfere. If your work involves a lot of verbal communication or auditory cues (like a call center, teaching, music, or even certain technical jobs), you may need accommodations like special headsets or repositioning in meetings. If imbalance is an issue, jobs that require climbing, quick movements, or operating vehicles/heavy machinery might be challenging or put on hold.
• Psychological stress of “watch and wait”: If your neuroma is being monitored with periodic MRIs, living with that uncertainty can be stressful. Every subtle change in hearing or balance might cause anxiety (“Is it growing? Will I need surgery soon?”). This stress can sometimes amplify the perception of symptoms.
• Post-treatment recovery: If you undergo surgical removal, there’s often an intense but temporary impact. You may have complete loss of vestibular function on that side after surgery (causing acute dizziness until compensation kicks in), plus surgical recovery (incision pain, fatigue). Some people have facial weakness that affects eating/drinking and appearance for a while. Even with radiation (Gamma Knife or similar), there can be a period of increased symptoms (so-called “tumor swell” effect) where hearing might dip further or balance worsens before stabilizing. This recovery period can be physically and emotionally taxing, requiring time off work and lots of support.
• Balance and independence: If your balance is significantly affected either by the tumor’s growth or post-treatment, you might find you need an assistive device (like a cane) in challenging environments, or at least to be more cautious. This can be a blow to independence if you were very active. You might temporarily limit driving (especially at night, when one relies more on inner ear, which might be down on one side). Activities like biking or sports that require good balance may be put on pause.
• Lifestyle adjustments: You may need to incorporate new habits, like protecting your remaining good ear from loud noise (to preserve hearing), doing regular balance exercises (to keep steady), and perhaps using a white noise machine for tinnitus at night. None of these are insurmountable, but they do represent lifestyle changes that require adjustment.

While all this sounds heavy, it’s important to remember that an acoustic neuroma is treatable and many people return to full, active lives. The role of physiotherapy is to minimize the functional impact – especially on balance – and speed up your adaptation to any changes.

Physiotherapy plays a vital role both before and after treatment of an acoustic neuroma. At Peak Sports and Spine Centre, our goal is to help you maintain or regain your balance function, manage dizziness, and adapt to hearing changes so you can continue living life to the fullest. Here’s how our physiotherapy for vestibular schwannoma supports you:

• Pre-Treatment “Prehab” (if applicable): If you and your doctors decide on surgery or radiation and you have some time before treatment, we often do “prehabilitation.” This involves baseline vestibular and balance tests, and starting you on some vestibular exercises early. By strengthening your balance system beforehand, you go into treatment more resilient. For example, we might start gaze stabilization exercises even if you only have slight issues – this can help your brain begin to rely more on the good ear and vision. We also educate you on what to expect post-treatment (e.g., “you might feel very dizzy the first few days after surgery, but don’t worry, that’s normal and we will tackle it with exercises A, B, C”). Knowing what lies ahead can reduce anxiety.
• Post-Surgery Vestibular Rehabilitation: If you undergo surgical removal, typically the vestibular nerve on that side is sacrificed to remove the tumor. This means you essentially wake up with one-sided vestibular loss. Initially, you’ll likely have intense vertigo and imbalance for a few days. We coordinate with your surgical team – often starting in the hospital – to begin gentle vestibular rehab as soon as feasible. This includes very basic exercises: learning to move your eyes and head a bit even if it causes dizziness (to stimulate compensation), sitting up and balancing with support, and walking with assistance. As you transition to outpatient therapy, we ramp this up. Gaze stabilization exercises (like focusing on a target while moving your head) are crucial to help your brain recalibrate to having input from only the remaining ear. Balance exercises will be quite challenging at first – we might start with you holding on to parallel bars doing weight shifts, then progress to free standing, and eventually more dynamic tasks. It’s often gratifying how quickly people improve in the first few weeks – the brain is working hard to adjust, and with the right exercises, it usually does well.
• Post-Radiation Rehab: If you had radiation (like Gamma Knife), vestibular function might gradually decrease over time as the tumor essentially stops the nerve from functioning fully. Rehab in this scenario is similar, but usually less acute. We’ll assess which movements or activities provoke symptoms and tailor exercises accordingly. You might not have as severe vertigo as surgery patients, but may have prolonged imbalance. We still use gaze stabilization, balance training, and habituation for any motion sensitivities. The difference is, we also monitor for any delayed effects of radiation (which can sometimes cause swelling months later) – if there’s a known period of potential flare-up, we schedule extra check-ins then.
• Hearing Compensation Strategies: While physiotherapy can’t restore hearing, we address the functional impact of single-sided hearing loss. We ensure during our sessions we communicate in a way that suits you (e.g., therapist will stand on your good ear side). We can help train your ability to locate sounds using other cues or turning your head. If you have a hearing aid or device like a CROS system (which routes sound from deaf ear to hearing ear), we integrate its use into therapy tasks so you get comfortable. For example, we might do a dual-task exercise where you’re balancing and listening to instructions from different sides – mirroring real life where you have to maintain balance while focusing on a speaker. We might also advise on environmental modifications: like at work, arrange your desk so your good ear faces the office; at home, consider mirror placements so you can see if someone approaches on your deaf side, etc. Our holistic approach means we aren’t just treating “the balance,” but helping you adapt in all ways.
• Facial Function Support: If you experienced any facial nerve issues from the tumor or treatment, we work in tandem with that. Gentle facial exercises, massage, and coordination with speech therapy or occupational therapy might be warranted. For instance, a weakened blink can lead to dry eye, which can blur vision and indirectly affect balance (if your vision is compromised, your balance suffers). We’d make sure you have the right eye care and incorporate maybe blinking exercises or simply be aware to have you take breaks if your eye is irritated during sessions. If part of your smile or facial muscles are weak, we keep an upbeat environment to encourage practice (like making exaggerated expressions as part of warm-ups). We liaise with specialists for any specific facial rehab, but are mindful of it during our sessions.
• Advanced Balance Rehab: As you progress, we introduce higher-level balance challenges. An acoustic neuroma patient post-treatment often has to get used to a new normal of having one balance system instead of two. That means your balance might never be quite as rock-solid in the dark as a person with two working vestibular nerves – but you can get very close. We’ll train you in scenarios that mimic real life: walking in a dark hallway (we might dim the lights and have you navigate obstacles), balance on a moving surface (simulating a boat or train, using a wobble board or Bosu), or rapid head movements (playing catch and throw while you quickly move your head to look between targets). If you have returned to work, we ensure you can handle the commute (we might do a session of exercises then have you quickly turn your head as if shoulder-checking while “driving” a therapy prop). For those who love sports, we integrate movements relevant to those sports (like quick lateral moves for tennis, or uneven terrain training for bushwalking). By the end of therapy, you’ll have confidence in everyday situations and knowledge of any limits.
• Long-term Self-Management: We empower you with a home program and strategies for the long haul. This includes a set of balance and eye exercises to do regularly (at least a few times a week) to keep your balance system sharp. We also counsel on healthy habits: protecting your good ear (wear ear protection in loud environments), staying active (the more you move, the more your brain adapts and maintains vestibular gains), and not hesitating to use a support in sketchy conditions (like a hiking pole on a slippery hike – it’s just smart prevention). Importantly, we make sure you know that if any new issues arise (like any sign of tumor regrowth which is rare, or simply aging-related balance changes decades later), you can come back for tune-up sessions. We stand as your long-term partners in health.

Throughout the process, our tone is confident and encouraging. An acoustic neuroma diagnosis and treatment can be daunting, but we reassure you that improvement is not just possible – it’s expected with the right effort and support. We celebrate each milestone: the first time you walk without feeling like drifting, the moment you return to work, or the day you report “I went for a walk in the park at night and felt okay!” Being a part of those victories is what we strive for.

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