Vestibular schwannoma

Background

• AKA vestibular schwannoma
• Schwann cell derived tumor of cranial nerve VIII
• Typically arise from vestibular division of CN VIII--> expands--> projects from internal auditory canal into cerebellopontine angle--> compresses CN VII and VIII
  • Less commonly, can continue to enlarge and compress cerebellum, brain stem, and CN V, IX, and/or XII

Clinical Features

• Hearing loss, sensorineural, slowly progressive or abrupt
• Vertigo/dysequilibrium
• Tinnitus, unilateral
• Otalgia or sensation of ear fullness/pressure
• Facial weakness or numbness if facial nerve involvement

Differential Diagnosis

Vertigo

• Vestibular/otologic
  • Benign paroxysmal positional vertigo (BPPV)
  • Traumatic (following head injury)
  • Infection
    • Labyrinthitis
    • Vestibular neuritis
    • Ramsay Hunt syndrome
  • Ménière's disease
  • Ear foreign body
  • Otic barotrauma
  • Otosclerosis
• Neurologic
  • Cerebellar stroke
  • Vertebrobasilar insufficiency
  • Lateral Wallenberg syndrome
  • Anterior inferior cerebellar artery syndrome
  • Neoplastic: cerebellopontine angle tumors
  • Basal ganglion diseases
  • Vertebral Artery Dissection
  • Multiple sclerosis
  • Infections: neurosyphilis, tuberculosis
  • Epilepsy
  • Migraine (basilar)
• Other
  • Hematologic: anemia, polycythemia, hyperviscosity syndrome
  • Toxic
    • Alcohol
    • Aminoglycosides
  • Chronic renal failure
  • Metabolic
    • Thyroid Disease
    • Hypoglycemia

Sensorineural hearing loss

• Sudden Sensorineural Hearing Loss (SSHL)
• Infections: (Meningitis, Viral cochleitis)
• Barotrauma
• Penetrating trauma
• Meniere Disease
• Autoimmune disease
• Multiple Sclerosis
• Cerebrovascular ischemia
• Tumors (Acoustic neuroma, Meningioma)
• Hereditary hearing loss
• Congenital viral infections
• Congenital malformations
• Presbycusis
• Thyrotoxicosis
• Ototoxic drugs: Aminoglycosides, Erythromycin, Tetracycline, chemotherapeutic agents, high-dose aspirin, phosphodiesterase-5 inhibitors (e.g. sildenafil, antimalarial drugs, Cocaine, Heavy Metals
• Otologic surgery
• Noise exposure

Evaluation

• Brain MRI
• Outpatient audiogram

Management

• Typically monitored without resection unless rapidly growing or bothersome symptoms

Disposition

• Discharge