Acoustic Neuroma

Acoustic neuroma — more accurately vestibular schwannoma — is a benign tumour arising from the Schwann cells of the vestibular portion of cranial nerve VIII. It is not cancer, it does not metastasize, and many are never operated on. Yet it sits in one of the least forgiving locations in the body: the internal auditory canal and cerebellopontine angle, packed with the facial nerve, the trigeminal nerve, the brainstem and the cerebellum. The central nursing message is a referral message. The overwhelming majority of these tumours announce themselves as progressive unilateral sensorineural hearing loss with tinnitus — a presentation so ordinary that it is routinely attributed to noise, age or wax. Asymmetric sensorineural hearing loss requires MRI to exclude a vestibular schwannoma. A nurse who recognizes that a one-sided, slowly worsening hearing loss is not normal ageing, and who ensures the referral happens, changes outcomes — because small tumours are managed with far better hearing and facial nerve preservation than large ones. The second theme is the cranial nerves. As the tumour grows it compresses neighbours in a fairly predictable...