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 with 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% 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 may be 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. People who have a sudden onset of symptoms, symptoms in only one ear and have family histories, should seek medical attention. At least some patients have been misdiagnosed with Meniere's disease as this can be very similar. Patients who are treated for sudden hearing loss with steroids may get improvement in hearing. This does NOT mean that AN has been ruled out. Steriods sometimes shrink the tumor and hearing improves – for a while.

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.

Department of Otolaryngology, University of Minnesota

University of Minnesota Physicians - Clinic and Appointment Information