ACOUSTIC NEUROMA-THE BASIC FACTS

Postoperative

Microsurgery of an AN is a complex and delicate procedure. The smaller the tumor at the time of surgery, the fewer the chances are for complications. As the tumor size increases, the chances of complications become greater. Thus, there may be problems with the cranial nerves affected by the tumor (like facial paralysis or hearing loss) following surgery which may or may not have been present before tumor removal.

Residual problems

Immediate postop : This period is the days or perhaps weeks following surgery. There is a possibility of fatigue or tiredness and increased drowsiness, although some patients may experience "survival euphoria" and a renewed sense of energy and vigor. A period of emotional lows is common as the patient adjusts to physical changes. One symptom which may occur after discharge is a nasal drip of clear colorless fluid, which is particularly noticeable when bending over. This should be reported to the surgeon right away due to the risk of infection following a cerebrospinal fluid leak which can be checked.

Follow-up period : After being discharged from the hospital, patients operated for an AN are followed up regularly (every 2-3 months for the first year, every 6 months for the 2nd year, and every year thereafter). These follow up visits are important to monitor the hearing (in patients operated by the MF or SO approach), facial nerve paralysis if any and for recurrence of tumor.

HEARING LOSS

With small tumors, it may be possible to save hearing. In larger tumors, especially those which have extended into the brain cavity, the hearing has usually been partially or totally lost and cannot be restored. This loss means that patient will continue having problems locating sound, hearing on the deaf side and understanding speech over high background noise. Consultation with an audiologist is required for these patients for amplification options like traditional hearing aids or a CROS hearing aid (a device which crosses sound over from the operated ear to the opposite ear). A 30 day free trial should be allowed before purchase.

TINNITUS

Ear noises usually remain the same as before surgery, though in a few cases noises may increase or begin after surgery. Tinnitus is from the hearing loss. A masking device may help some people affected by tinnitus. The newer BAHA (Bone Anchor Hearing Aid) may also be helpful.

FACIAL WEAKNESS OR PARALYSIS

Since the facial nerve which controls muscles of facial expression is in close proximity with the AN, it is usually necessary to manipulate and at times remove the portion of the nerve. In some cases however, even though the nerve is intact after surgery, nerve damage or swelling may cause temporary or in some cases permanent facial paralysis. Immediately after the operation, facial weakness may get a little worse. This usually recovers quickly. Regrowth of the nerve is a slow process which may take up to a year for recovery to be noticeable. If recovery is not observed by 1 year, a second operation may be required to connect the healthy portion of the facial nerve to a nerve in the neck usually the one supplying one side of the tongue. This procedure is called the hypoglossal-facial (12-7) nerve anastamosis which restores some but not all facial movement. Spontaneous movements like laughing are asymmetric. There may be loss of tongue function. There are some other procedures which adapt available muscles and nerves to help in toning or reanimating the sagging face. If it becomes necessary to remove a portion of the facial nerve during surgery, the facial nerve may be reconnected directly or by inserting a nerve graft. Usually, the result is asymmetric but will provide some spontaneous movement.

EYE PROBLEMS

Studies have shown that at least half of those who have had an acoustic neuroma removed develop long term eye discomfort and other eye problems, particularly if the tumor was medium or large. Loss of eyelid function and/or altered tear production can cause irritation and scratchiness in the eye because it is dry & unprotected. To deal with this problem, there are various surgical procedures which can be done to protect the cornea. They include canthoplasty (bringing together tendons in either or both corners of the eye), a gold weight implant in the upper lid; and a tarsorapphy (sewing the lids together). Artificial tears or eye lubricants maybe needed for a short time or permanently. Taping part of the lids together, using protective glasses and moisture chamber, using bandage contact lenses and avoiding eye irritants may be helpful. In a few patients, double vision may be present due to pressure on the 6th cranial nerve which controls the muscles that move the eyes.

TASTE DISTURBANCE AND MOUTH DRYNESS OR EXCESSIVE SALIVATION

There maybe some change in taste and amount of saliva secretion for a short time following surgery. In some cases this may be prolonged. In the others, increased salivation occurs while chewing or there maybe increased tearing while eating. The appetite maybe affected for some time.

SWALLOWING, THROAT AND VOICE PROBLEMS

In a small number of patients, AN surgery affects the nerves which control the throat, swallowing and voice production leading to hoarseness & difficulty in swallowing. These symptoms usually improve slowly over time.

BALANCE PROBLEMS

The vestibular portion of the VIII nerve is almost always removed during surgery. Usually this part of the nerve is non-functional and has already been destroyed because of the AN. Dizziness is common following surgery and maybe severe for a time. After a while, the balance apparatus of the opposite or normal ear compensates for this loss, and balance improves. This compensation may not be perfect, particularly in darkness, when the patient is fatigued, when there is a sudden change in body position, or while walking on uneven surfaces. Remarkably, most people who have dizziness before surgery get improvement in their balance after the operation. Maintaining good general physical health through proper diet and moderate exercise, can improve balance & general vitality to a great extent.

FATIGUE

Fatigue sometimes remains a prolonged problem for some patients after some of the other symptoms have subsided. It is important in such patients to adjust their pace of life in harmony with their energy level. This remains the main complaint of patients for the first 6-8 weeks after surgery.

HEADACHE

Headaches can be a problem for some patients while still in the hospital. This maybe related to tension from holding the head rigidly, changes in intracranial pressure, muscle spasm, or anxiety. Headaches are almost never related to tumor recurrence. Treatment is with analgesics & muscle relaxation. If severe headaches persist after hospital discharge, medical help should be sought. Repair of bone defects, even years after surgery, can sometimes improve headaches.

DENTAL CARE

If the patient has facial paralysis, food tends to get lost in the mouth on the affected side and can lead to dental problems. Washing and rinsing the mouth is therefore necessary, as well as brushing & flossing the teeth several times a day is important.

PROTECTING THE OTHER EAR

It is important to provide sensible protection to the opposite or good ear which has the remaining hearing apparatus. This is done by avoiding extreme or sudden exposure to loud noises like firearms or some cordless phones near the good ear. Some physicians suggest follow-up MRI scans and/or audiograms for some time following AN removal.

PSYCHOLOGICAL COPING

For some patients, adjustment to a new self after AN removal can be a challenging task. This is because in addition to changes in hearing, the appearance may now be altered along with the presence of other impairments. Return to normal activity may be slow. Concentrating on strengths rather than on weaknesses will help such patients to return to all former activities and also expand their abilities in new areas.

Department of Otolaryngology, University of Minnesota

University of Minnesota Physicians - Clinic and Appointment Information