Symptoms

Early symptoms of AN can occur in other conditions of the ear that can be easily overlooked. There is no typical pattern of symptoms which again makes early diagnosis of AN quite challenging. However, there are symptoms that act as indicators to the possibility if an AN. Patients with "inner ear" problems should be completely evaluated to rule out AN as a cause of these symptoms. It is possible that Meniere's disease or hardening of the bone of the middle ear (otosclerosis) could be causing these symptoms. Patients with AN may present the following symptoms:

• Hearing loss
• Ringing in the ears (tinnitus)
• Dizziness (vertigo)
• Difficulty in balance (imbalance or dysequilibrium)
• Fullness or pressure in the ears
• Facial numbness or paralysis (for very large tumors)

HEARING LOSS
In over 90 percent of the patients with AN, the first symptom is a reduction in hearing in one ear due to involvement of the VIII nerve. This is usually accompanied by ringing in the ears or ear noise-also called "tinnitus". The hearing loss is usually subtle and worsens very slowly over a period of time. In some cases, there maybe a sudden loss of hearing. Some patients may experience a sense of fullness in the affected ear. Unfortunately, since hearing loss is often mild and there is no pain, patients tend to ignore the change in hearing and merely shift the phone to the opposite ear or make other compromises for the one-sided hearing loss rather than seek medical attention.

VERTIGO & IMBALANCE
Since the tumor usually arises from the vestibular nerve which is responsible for balance, unsteadiness or balance problems may be one of the earlier symptoms in the growth of the tumor. Since the remainder of the balance system compensates for this loss, balance problems may be forgotten after some time.

As the tumor grows larger in size and starts pressing over other nerves, mainly the trigeminal nerve, facial sensation may be affected. The patients will then experience numbness and facial tingling, constantly or intermittently. Patients may also have facial tics or spasms. As the tumor grows larger or presses on the brainstem, the patient will experience headaches, facial weakness, vertigo and unsteady gait due to raised intracranial pressure.

Send e-mail to Dr. Sam C Levine, M.D.: levin001@umn.edu

Written and designed by Vikram J. Jaisinghani, M.D., Department of Otolaryngology, University of Minnesota