Vestibular schwannoma (acoustic neuroma)
Vestibular schwannoma, also known as acoustic neuroma, is a type of low grade brain tumour that mostly affects adults. They account for 8% of all primary brain tumours, which are tumours that start in the brain instead of spreading to it.
Short summary
Vestibular schwannomas, or acoustic neuromas, are brain tumours that usually form in the nerves between the ear and the brain. These tumours are low grade, which means they’re not cancerous.
Vestibular schwannomas can affect people of all ages. But, they mostly affect people between the ages of 40 and 60.
Symptoms can include loss of hearing, ringing in the ear, loss of balance, headaches, and blurred vision.
Treatment for vestibular schwannomas can range from ‘watch and wait’ to surgery and radiotherapy.
- What is a vestibular schwannoma?
- Vestibular schwannoma symptoms
- What causes vestibular schwannoma?
- How are vestibular schwannomas diagnosed?
- How is a vestibular schwannoma treated?
- Vestibular schwannoma life expectancy
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What is a vestibular schwannoma?
Vestibular schwannoma (also sometimes called acoustic neuroma) is a slow-growing tumour that forms near the nerves of the ear. These tumours are low grade, which means they are non-cancerous, or benign.
These tumours affect people of all ages, but are most common in people between the ages of 40 and 60. More than 90% of vestibular schwannomas occur in people without a history of these tumours in their family.
Schwannomas develop from Schwann cells which are cells on the outside of nerves. Schwann cells produce a special type of coating (called myelin) which wraps around the nerves. This coating allows impulses to travel quickly along the nerves.
A vestibular schwannoma is a schwannoma that grows from Schwann cells on the vestibular nerve.
The vestibular nerve is part of the vestibularcochlear nerve (also known as the cranial nerve eight), which is responsible for balance, eye movements and hearing.
Vestibular schwannoma symptoms
Common vestibular schwannoma symptoms are:
- Hearing loss, which gets worse over time
- Ringing in the ear (on one or both sides)
- Sensation of feeling off balance, veering off to the side when walking, of moving or spinning of the environment (vertigo).
- Fatigue
Larger tumours may cause neurological side effect, but they are less frequent. These could be:
- Headache
- Facial pain
- Hydrocephalus (build-up of fluid in the brain) causes an increase in pressure within the skull, which then leads to a wide range of symptoms (for example nausea and vomiting, blurred vision or difficulty walking).
What causes vestibular schwannomas?
It’s important to know that there is nothing you could have done, or avoided doing, that would have caused you or somebody you know to develop a brain tumour.
As with other brain tumours, the cause of most vestibular schwanomma is unknown, but there is an understanding that genetics can be involved.
Although most of the vestibular schwannomas occur in people without a history of these tumours in their family, some tumours are related to a genetic disorder called Neurofibromatosis type 2 (NF2).
NF-2 is a genetic condition that causes low grade tumours to grow along your nerves. It’s caused by a permanent change (mutation) in a gene that makes the growth of nerve tissue become uncontrolled. In half of all cases of NF-2, the mutation is passed from parent to child. There are genetic tests that can be carried out during pregnancy to test whether your child will have NF-2, but it’s normally diagnosed after birth.
Vestibular schwannoma diagnosis
Vestibular schwannoma diagnosis can be difficult as their symptoms can be similar to other conditions. For example, hearing loss might be put down to age or exposure to high levels of noise earlier in life.
They are usually diagnosed after:
- routine auditory tests to reveal any loss of hearing and speech decline
- an audiogram to evaluate the level of hearing in both ears
- tests to check your sense of balance, reflexes and the strength in your arms and legs
- a diagnostic scan (usually an MRI), if there’s a noticeable loss of hearing in one ear.
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Vestibular schwannoma treatment
Conservative (watch and wait)
Some vestibular schwannomas may not need immediate treatment. This is usually when they are small and causing mild symptoms.
If this is the case, you’ll usually be put on active monitoring (also called “watch and wait”) and you’ll see your specialist for regular check-ups or MRI scans.
Surgery for vestibular schwannomas
Neurosurgery is usually only used to remove larger vestibular schwannoma brain tumours. This is because surgery can can result in the loss of hearing in the affected ear as well as incoordination, facial weakness and balance problems.
Surgery can also result in damage to the facial nerve, causing your face to droop on one side or make it difficult to close that eye. If this happens, healthcare professionals will refer you to an eye specialist and specialist palsy therapist to help you recover.
Your surgeon will explain what is involved in the procedure and potential risks and complications. The surgeon may leave a small part of the tumour to prevent damage to the facial nerve. Any tumour cells that are left behind can be treated with stereotactic radiosurgery.
You may wish to discuss the possibility of having a ‘bone anchored hearing aid’ with your surgeon. This diverts sound from your affected ear to your good ear.
Radiotherapy
Radiotherapy uses beams of radiation to try to destroy tumour cells.
Some patients may benefit with this treatment. The main aim of radiotherapy is to prevent tumour growth. Stereotactic radiotherapy is the most used.
Emerging treatments
As the knowledge of vestibular schwannoma grows, targeted therapies are emerging.
Clinical trials are being conducted using Bevacizumab, Everolimus and Lapatinib as potential options for treating vestibular schwannomas.
Vestibular schwanommas very rarely return after surgery, but you may continue to have regular MRI scans.
Even with treatment, symptoms such as tinnitus and hearing loss can persist. These symptoms will require additional treatment.
Vestibular schwannoma life expectancy
Vestibular schwannomas are rarely life-threatening. This is because they are relatively uncommon and are usually slow-growing.
Some of these tumours might not need to be treated right away, while others can be treated with surgery and stereotactic radiosurgery.
Because of the nature of the tumours themselves and the treatments available, the vestibular schwannoma life expectancy for people affected is quite promising. With a qualified doctor checking their symptoms regularly, most people with these tumours can live normal lives for many years.
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- Verified by: S Cooper – Lead Physiotherapist in Neuro-Oncology
- Date checked: 28/02/26
- Next check: 28/02/29
Stangerup S‑E et al., 2006. Natural History of Vestibular Schwannoma, Otology & Neurotology 27(6): 964–71 Oxford Academic, PubMed Central, journals.lww.com
Long-term growth study (PMCID 9340632), 2022: Growth-free survival data PubMed Central
Life expectancy study, 2023: ~10.7 years (female), 8.9 years (male) PubMed Central, researchgate.net
Cancer Research UK tumour overview and treatment options Cancer Research UK
NHS patient leaflet on acoustic neuroma and prognosis NHS
ACNR review of management strategies ACNR
EANO 2021 guideline on diagnosis & treatment PubMed Central
MDPI qualitative review of management factors in VS MDPI
Epidemiology incidence: 1.09/100,000 US; demographic trends PubMed
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