February 3, 2017

Vertigo is a type of dizziness. It is described as a ‘spinning’ sensation in the head and is usually brought on by sudden changes in position.

Some people say it feels like standing still in a spinning room. You may feel like you are going to fall over. While there are some serious causes of vertigo, in most cases it is not a serious condition and usually gets better with time.

Attacks of vertigo can develop suddenly and last for a few seconds, or they may last much longer. If you have severe vertigo, your symptoms may be constant and last for several days, making normal life very difficult. Other symptoms associated with vertigo may include –

  • Loss of balance – which can make it difficult to stand or walk
  • Feeling sick or being sick
  • Dizziness

Types and Causes of Vertigo

  • Peripheral vertigo – Peripheral vertigo is a term that collects together the inner ear causes. The labyrinth of the inner ear has tiny organs that enable messages to be sent to the brain in response to gravity. By telling our brains when there is movement from the vertical position, we are able to keep our balance, maintain equilibrium. Viral infection is behind the inflammation seen in the following two conditions.
    • Labyrinthitis – this is inflammation of the inner ear labyrinth and vestibular nerve (the nerve responsible for encoding the body’s motion and position7)
    • Vestibular neuronitis – this is thought to be due to inflammation of the vestibular nerve.
    • Ménière’s disease can also be caused by inflammation, but this can be due to bacterial as well as viral infection.
  • Benign paroxysmal positional vertigo (BPPV) is thought to be caused by a disturbance in the otolith particles. These are the crystals of calcium carbonate within inner ear fluid that pull on sensory hair cells during movement and so stimulate the vestibular nerve to send positional information to the brain.

Benign paroxysmal positional vertigo is twice as common in women as men, usually affects older people and most often arises without a known cause (idiopathic). While most cases are spontaneous, BPPV vertigo can also follow –

  • A head injury
  • Reduced blood flow in a certain area of the brain (vertebrobasilar ischemia)
  • An episode of labyrinthitis
  • Ear surgery
  • Prolonged bed rest.


  • Central vertigo is a term that collects together the central nervous system causes – involving a disturbance to one of the following two areas –

The parts of the brain (brainstem and cerebellum) that deal with interaction between the senses of vision and balance, or

  • Sensory messages to and from the thalamus part of the brain.
  • Migraine headache is the most common cause of central vertigo.

Uncommon causes are stroke and transient ischemic attack, cerebellar brain tumor, acoustic neuroma (a non-cancerous growth on the acoustic nerve in the brain) and multiple sclerosis.

Activities that bring on a dizzy spell can vary. They often involve moving your head into a certain position suddenly, such as:

  • looking up
  • lying on one ear
  • rolling over in bed
  • getting out of bed
  • bending over.


  • Dizziness – this begins seconds after a certain head movement and lasts less than a minute.
  • Feeling light-headed.
  • Balance problems.
  • Nausea – feeling like you are going to vomit.

These symptoms usually get better once you are in a different position. Pain, ringing in the ears (tinnitus) or deafness is not common.

If you have more serious symptoms – speech difficulty, double vision, unsteady walking, difficulty swallowing, altered strength or feeling in your legs or arms, ringing in your ears or deafness – you should seek medical help.


Treatment of vertigo depends on its cause. If a specific causative disease is identified, therapy can be tailored for that disorder. Frequently there can be multiple, coincident causes of vertigo, and each needs to be treated individually. Surgery can be helpful and even curative for many causes of vertigo. There are a number of different operations that can eliminate vertigo from various inner ear diseases. In general, surgery is reserved for patients in whom more conservative treatments have failed to control the symptoms. Medications are often helpful in controlling the acute symptoms of vertigo, but can frequently be counter-productive for people with more chronic problems.

In certain cases, one specific cause of vertigo cannot be identified, but, depending on the nature of the vertigo treatment may still be provided with good hope for improvement. In many such instances, vestibular rehabilitation therapy (VRT) is the recommended approach.

Alternative Treatment

Vitamin B6 – This vitamin is essential for the brain and the nervous system to function normally; getting enough is vital for avoiding migraine attacks.

Vitamin D – The inner ear is partly responsible for your sense of balance, so any ear problems may cause migranes. Getting enough vitamin D is vital for your ear health.

Vitamin B12 – This is the usual vitamin deficiency suspect if you’re experiencing dizziness. Vitamin B-12’s primary functions are in the formation of red blood cells and the maintenance of a healthy nervous system.

Antioxidants—Antioxidants mitigate the damaging effects of free radicals on tissues, cell membranes, and DNA. Vitamin C, vitamin E, lipoic acid, and glutathione are among the most important antioxidants. Vitamin C has been shown to have a beneficial effect on patients with Ménière’s disease when given in combination with glutathione.

Ginkgo biloba—Researchers have found that dizziness induced by vestibular receptor impairment can be reduced by Ginkgo biloba extract.

Ginger – Ginger, or Zingiber officinale, is a perennial used in cooking and herbal medicine. It’s a traditional remedy for stomach problems, nausea, fever, coughs and diarrhea. The rhizomes are rich in volatile oil, and have antibacterial, cholesterol-lowering, hypoglycemic and anti-ulcer action.

Vertigoheel – A randomized, double-blind trial was performed in 2005 of 170 elderly patients with atherosclerosis-related vertigo to assess the noninferiority of Vertigoheel versus ginkgo biloba

Acupuncture has been used for patients with Menie`re disease and for relief of vertigo.

Osteopathic manipulative therapy (OMT) has been described for disorders of dizziness and balance. OMT is taught in schools of osteopathic medicine and is also practiced by physical therapists and physiatrists.


Reference –

February 3, 2017
February 3, 2017
February 3, 2017

Meniere’s disease is characterised by recurrent attacks of vertigo accompanied by fluctuating sensorineural hearing loss, tinnitus and a sense of aural fullness. Prosper Meniere in 1861 correctly attributed the attacks to a disorder of the inner ear, suggesting that the mechanism of causation could be similar to migraine or inner ear vasospasm, a differential diagnosis which is still relevant for the disease today.

Ménière’s disease is also called idiopathic endolymphatic hydrops and is one of the most common causes of dizziness originating in the inner ear. Attacks of dizziness may come on suddenly or after a short period of tinnitus or muffled hearing. Some people will have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. Some people with Meniere’s disease have vertigo so extreme that they lose their balance and fall. These episodes are called “drop attacks.”

Meniere’s disease can develop at any age, but it is more likely to happen to adults between 40 and 60 years of age. The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that approximately 615,000 individuals in the United States are currently diagnosed with Meniere’s disease and that 45,500 cases are newly diagnosed each year.

Meniere’s disease can occur at any age, but it usually starts between the ages of 20 and 50. It is a chronic (long-term) disease, but treatments and lifestyle changes can help to ease the symptoms.


The symptoms of Meniere’s disease are caused by the buildup of fluid in the compartments of the inner ear, called the labyrinth. The labyrinth contains the organs of balance (the semicircular canals and otolithic organs) and of hearing (the cochlea). It has two sections: the bony labyrinth and the membranous labyrinth. The membranous labyrinth is filled with a fluid called endolymph that, in the balance organs, stimulates receptors as the body moves. The receptors then send signals to the brain about the body’s position and movement. In the cochlea, fluid is compressed in response to sound vibrations, which stimulates sensory cells that send signals to the brain.

Factors that affect the fluid, which might contribute to Meniere’s disease, include:

  • Improper fluid drainage, perhaps because of a blockage or anatomic abnormality
  • Abnormal immune response
  • Allergies
  • Viral infection
  • Genetic predisposition
  • Head trauma
  • Migraines

In Meniere’s disease, the endolymph buildup in the labyrinth interferes with the normal balance and hearing signals between the inner ear and the brain. This abnormality causes vertigo and other symptoms of Meniere’s disease.


  • Episodic rotational vertigo – Attacks of a spinning sensation accompanied by disequilibrium (an off-balanced sensation), nausea, and sometimes vomiting. This is usually the most troublesome symptom. The vertigo usually last 20 minutes to four hours or longer. During attacks, patients are very disabled, and sleepiness may follow. An off-balanced sensation may last for several days.
  • Tinnitus – A roaring, buzzing, machine-like, or ringing sound in the ear. It may be episodic with an attack of vertigo or it may be constant. Usually the tinnitus gets worse or will appear just before the onset of the vertigo.
  • Hearing loss – It may be intermittent early in the onset of the disease, but overtime it may become a fixed hearing loss. It may involve all frequencies, but most commonly occurs in the lower frequencies. Loud sounds may be uncomfortable and appear distorted in the affected ear.
  • Ear fullness – Usually this full feeling occurs just before the onset of an attack of vertigo.


  • Intermittent anti-vertigo medications, e.g lorazepam, diazepam or meclizine.
  • Intratympanic injections
  • Surgical intervention

While anti-vertigo and anti-nausea medications will reduce dizziness, they may cause drowsiness and can prologue the dizziness after spell. Other treatments also carry both positive implications as well as drawbacks. When is surgery recommended? The vast majority of patients with Meniere’s disease are controlled with medication and lifestyle changes.

If vertigo attacks are not controlled by conservative measures and are disabling, one of the following surgical procedures might be recommended

  • Intratympanic gentamicin injections – This is done with 2 out-patient injections of gentamicin into the middle ear. Some of the gentamicin enters the inner ear through the membranes separating the middle and inner ear. The aim of the procedure is to reduce the irritability of the inner ear and control the spells.
  • The endolymphatic sac shunt or decompression procedure is an ear operation that usually preserves hearing. Attacks of vertigo are controlled in one-half to two-thirds of cases, but control is not permanent in all cases. Recovery time after this procedure is short compared to the other procedures.
  • Selective vestibular neurectomy is a procedure in which the balance nerve is cut as it leaves the inner ear and goes to the brain. While vertigo attacks are permanently cured in a high percentage of cases, patients may continue to experience imbalance. Similar to endolymphatic sac procedures, hearing function is usually preserved.
  • Labryrinthectomy and eighth nerve section are procedures in which the balance and hearing mechanism in the inner ear are destroyed on one side. This is considered when the patient with Meniere’s disease has poor hearing in the affected ear. Labryrinthectomy and eighth nerve section result in the highest rates for control of vertigo attacks.

Noninvasive therapies and procedures

Some people with Meniere’s may benefit from other noninvasive therapies and procedures, such as –

  • Rehabilitation – If a person has balance problems between episodes of vertigo, vestibular rehabilitation therapy might improve your balance.
  • Hearing aid – A hearing aid in the ear affected by Meniere’s disease might improve your hearing.
  • Meniett device – For vertigo that’s hard to treat, this therapy involves applying pressure to the middle ear to improve fluid exchange. A device called a Meniett pulse generator applies pulses of pressure to the ear canal through a ventilation tube.

Alternative Treatment

  • Lysine – A naturally occuring amino acid, lysine is popular treatment of vertigo.
  • Manganese – Maganaese (in trace amounts) is helpful for Meniere’s disease.
  • Mycostatin (Nystatin) – Studies suggest that this antifungal is very effective for intractable Meniere’s disease.
  • Kava – This herbal preparation is used for anxiety and insomnia. It’s action seems to be a GABA agonist and possibly a mild 5-HT 1A action. It may be effective for anxiety.
  • Ginkgo biloba is one of the most well researched herbs in the world. It has been shown to be anti-ischaemic, anti-hypoxic and a radical scavenger. It increases efficiency of metabolism, regulates neurotransmitters and boosts oxygen levels in the brain.
  • Vitamin C – The next substance is a particular sort of vitamin C, a timed release form of this essential vitamin. In larger amounts, vitamin C is quickly removed from the body and excreted. A timed release form maintains adequate concentrations of vitamin C in the blood for extended periods of time
  • Vitamin E (in the d-, not dl- forms) also has been shown to improve vascular health—along with a number of other good nutritional benefits. Vitamin E is much more effective when used along with vitamin C. The two vitamins work synergistically.
  • Acupuncture has been widely used in the treatment of Meniere’s disease. In Meniere’s disease, the needle stimulation is performed around the ear. The stimulation of acupoints is postulated to release natural opiates from nerves resulting in endogenous analgesia
February 3, 2017

Leukoplakia is a white or gray-white patch in the mouth that cannot be wiped off. The patches usually develop slowly, over weeks or months. They are rarely cancerous. A test called biopsy may be done to determine if they are cancerous or not. A biopsy involves removing a small section of the patch so it can be examined in a lab. If the patch is small, all of it is removed.

Leukoplakia is more common in people exposed to –

  • Chewing tobacco
  • Cigarette, cigar or pipe smoke
  • Sun on the lips
  • A mouthwash or toothpaste that contains sanguinarine

Leukoplakia is often seen on the lip or inside the cheeks or gums. Patches vary in size. Leukoplakia is usually benign (not cancer). On average, 4% to 5% of these patches develop into oral cancer. Patches in some areas of the mouth are more likely to be cancer –

  • On the tongue
  • On the lip
  • Under the tongue, on the “floor” of the mouth

People infected with HIV sometimes have a condition called oral hairy leukoplakia. It consists of hairy, painless white patches. Usually the patches are on the sides of the tongue. They can be one of the first signs of HIV infection

Leukoplakia usually isn’t dangerous, but it can sometimes be serious. Although most leukoplakia patches are noncancerous (benign), some show early signs of cancer. Many cancers on the floor of the mouth — beneath the tongue — occur next to areas of leukoplakia.


Leukoplakia affects the mucus membranes of the mouth. The exact cause is not known. Doctors think it may be due to irritation such as –

  • Rough teeth
  • Rough places on dentures, fillings, and crowns
  • Smoking or other tobacco use (smoker’s keratosis), especially pipes
  • Holding chewing tobacco or snuff in the mouth for a long period of time
  • Drinking a lot of alcohol
  • The disorder is most common in elderly persons.

A type of leukoplakia of the mouth called hairy leukoplakia is caused by the Epstein-Barr virus. It is seen mostly in persons with HIV/AIDS. It may be one of the first signs of HIV infection. Hairy leukoplakia can also appear in other people whose immune system is not working well, such as after a bone marrow transplant.


Leukoplakia causes patches on the tongue, gums, or inside of the cheeks. These patches may appear as –

  • White, gray, or red in color
  • Thick, slightly raised, or hardened on the surface
  • There may be pain or signs of infection. The patches may also be sensitive to touch, heat, or spicy foods.

In some cases, leukoplakia looks like oral thrush, which is an infection also associated with HIV infection and suppressed immune function.

Untreated leukoplakia can turn into cancer. Some types of leukoplakia carry a higher risk of turning into cancer than others.


If the patches do not fade as expected, the doctor may advise:

  • Topical medications or solutions that are applied to the patches
  • Medicated mouthwashes
  • Oral medications, such as retinoids, vitamin A, beta carotene, or lycopene
  • Antiviral medications—if the leukoplakia is due to viral infection (more common in people with suppressed immune function)
  • Treat dental causes such as rough teeth, irregular denture surface, or fillings as soon as possible.
  • Stop smoking or using other tobacco products.
  • Do not drink alcohol.

Removal of leukoplakic patches – Patches may be removed using a scalpel, a laser or an extremely cold probe that freezes and destroys cancer cells (cryoprobe).




  • Avoiding all tobacco products – This is one of the best steps you can take for your overall health, as well as being one of the main ways to prevent leukoplakia. Talk to your doctor about methods to help you quit. If friends or family members continue to smoke or chew tobacco, encourage them to have frequent dental checkups. Oral cancers are usually painless until fairly advanced.
  • Avoiding or limiting alcohol use – Alcohol is a factor in both leukoplakia and oral cancer. Combining alcohol and smoking may make it easier for the harmful chemicals in tobacco to penetrate the tissues in your mouth.
  • Eating plenty of fresh fruits and vegetables – These are rich in antioxidants such as beta carotene, which reduce the risk of leukoplakia by deactivating harmful oxygen molecules before they can damage tissues. Foods rich in beta carotene include dark yellow, orange, and green fruits and vegetables, including carrots, pumpkin, squash, cantaloupe and spinach.

If removing the source of the irritation does not work, the doctor may suggest applying medicine to the patch or using surgery to remove it.

Alternative Treatment

Vitamin A is very useful in the treatment of leukoplakia. Vitamin A can help improve general health and immunity of your body. It is very effective in treating leukoplakia and preventing remissions. Retinoids are derived from vitamin A and used in ointments to treat leukoplakia topically.

Vitamin E is a natural antioxidant and helps protect cell membranes from any harm due to free radicals. It is very beneficial in the treatment of leukoplakia and is recommended to be taken along with vitamin A to get its best health benefit.

Vitamin C is widely prescribed for the treatment of leukoplakia. Vitamin C is an antioxidant and helps to keep the body cells healthy. It also helps in the regeneration of new skin cells.

Vitamin B6 plays a vital role in production of new red blood cells and is also useful in strengthening the immune system. It is indicated for people suffering from leukoplakia as it has been observed that people with vitamin B6 deficiency are more likely to develop this condition.

Vitamin B9 – Also known as folic acid, this vitamin is very useful in the treatment of leukoplakia. It plays an important role in the synthesis of nucleic acid and helps to repair the DNA and RNA.

Beta-carotene – this compound has been the universal treatment supplement in all patients. he efficacy of the compound and its ability to deal with leukoplakia.

Reference –












February 3, 2017

Ear infections happen when the middle ear becomes inflamed. The middle ear is the small space behind the eardrum. Ear infections are also called acute otitis media. They can happen in one or both ears.

There are three main parts of the ear: outer, middle, and inner –

  • The outer ear is the opening outside of the body.
  • The middle ear houses delicate bones that aid in hearing.
  • The inner ear holds organs that control hearing and balance.

The Eustachian tube regulates air pressure within the middle ear, connecting it to the back of the nose and throat.

Acute otitis media occurs when a cold, allergy, or upper respiratory infection, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube. This causes earache and swelling.

Acute otitis media with effusion is caused by germs or viruses that grow. As they grow, they cause pus to form behind the eardrum. This infection is usually very painful. Acute otitis media without effusion is a very early infection before the middle ear fluid has formed. The eardrum is usually red and painful.

It is a very common infection. Every year in America about 1 in 10 children (particularly children younger than 4 years old) will have a middle ear infection, compared with about 1 in 100 adults. By age three years, 50 – 85% of children will have had acute otitis media. The incidence peaks between age 6 – 12 months, and recurrent acute otitis media is common, affecting 10 – 20% of children by age one year.


Acute otitis media (middle ear infection) is usually due to a combination of factors that increase susceptibility to bacterial and viral infections in the middle ear. The primary setting for middle ear infections is in a child’s Eustachian tube, which runs from the middle ear to the nose and upper throat. The Eustachian tube is shorter and narrower in children than adults, and therefore more vulnerable to blockage. It is also more horizontal in younger children and therefore does not drain as well.

Infections – Many bacteria and viruses normally thrive in the passages of the nose and throat. Most are not harmful. However, certain types of bacteria are the primary causes of acute otitis media (AOM). They are detected in about 60% of cases. The bacteria most commonly causing ear infections are – Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis etc.

Viruses play an important role in many ear infections, and can set the scene for a bacterial infection. Rhinovirus is a common virus that causes a cold and plays a leading role in the development of ear infections. It is not the direct infecting organism, however. If a cold does occur, the virus can cause the membranes along the walls of the inner passages to swell and obstruct the airways. If this inflammation blocks the narrow Eustachian tube, the middle ear may not drain properly.

Medical or Physical Conditions that Affect the Middle Ear – Any medical or physical condition that reduces the ear’s defense system can increase the risk for ear infections. Children with shorter than normal and relatively horizontal Eustachian tubes are at particular risk for initial and recurrent infections. Inborn structural abnormalities, such as cleft palate, increase risk. Genetic conditions, such as Kartagener’s syndrome in which the cilia (hair-like structures) in the ear are immobile and cause fluid build up, also increase the risk.

Genetic Factors – Several studies suggest that multiple genetic factors may make a child more susceptible to acute otitis media. Abnormalities in genes that affect the defense systems (cilia and mucus production) and the anatomy of the skull and passages would also increase the risk for ear infections.

Risk Factors

Risk factors for acute otitis media include –

  • Age – children between 6 – 36 months are most likely to get ear infections
  • Attending daycare
  • Recent illness, such as a cold or sinus infection
  • History of allergies, like hay fever, also called allergic rhinitis, or sinusitis
  • Exposure to secondhand smoke
  • Having family members who are prone to ear infections; studies show a clear genetic component for both acute and recurrent otitis media
  • Using a pacifier
  • Having a history of gastroesophageal reflux disease (GERD)

Children who are most at risk of a middle ear infection include –

  • Those born with a cleft palate
  • Those with a weakened immune system due to another illness or medicines they may be taking
  • Aboriginal children living in over-crowded conditions.


Ear infections can be painful. Trapped fluid puts pressure on the eardrum, causing it to bulge. Other symptoms include –

  • Ear pain – This symptom is obvious in older children and adults, but for children who cannot yet speak, you should watch for other signs, like irritability or a great deal of crying.
  • Loss of appetite – This may be most noticeable in young children, especially during bottle feedings. Pressure in the middle ear changes as the child swallows, causing more pain and less desire to eat.
  • Irritability – Any kind of continuing pain may cause irritability in children and adults. Poor sleep: Pain may be worse when the child is lying down, as fluid is shifting.
  • Fever – Ear infections can cause temperatures up to 104° F.
  • Drainage from the ear – Yellow, brown, or white fluid that is not earwax may seep from the ear. This may mean that the eardrum has ruptured (broken).
  • Difficulty hearing – Bones of the middle ear connect to the nerves that send electrical signals (as sound) to the brain. Fluid behind the eardrums slows down movement of these electrical signals through the inner ear bones.


  • Impaired hearing – Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually returns to what it was before the infection after the infection clears. Persistent infection or persistent fluids in the middle ear may result in more significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.
  • Speech or developmental delays – If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.
  • Spread of infection – Untreated infections or infections that don’t respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain.
  • Tearing of the eardrum – Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.


Antibiotics – Antibiotics, prescribed by your doctor, may be needed to kill the bacteria that are causing the ear infection. Do not forget to take or give it in regular doses until the bottle is empty, even if the pain and fever are gone. Finishing the medicine will keep the ear infection from flaring up again.

Antibiotics may cause nausea, diarrhea, rashes, or yeast infections, and may also interact with other medications. Rarely, allergic reactions can occur.

Ear drops – If the child has recurring ear infections, a perforated eardrum, or develops infection after ear tubes have been placed (see Surgery and Other Procedures), the doctor may prescribe antibiotic ear drops instead of oral antibiotics, to be used over a period of time, such as a few months.

Ibuprofen, acetaminophen – Ask the doctor about using over-the-counter oral medications for pain or fever, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Children under 19 should not take aspirin, due to the risk of developing a rare but serious illness called Reye’s syndrome.

Surgical Treatments – If the ear infection keeps coming back or lasts for a long time, the doctor may suggest surgery.

Alternative Treatment

Probiotics – So-called “good” bacteria or probiotics help prevent infections in the intestines, and there is preliminary evidence that they might help prevent colds, too

Xylitol – A sugar alcohol produced naturally in birch, strawberries, and raspberries, it may help fight a type of bacteria that’s associated with ear infections. Studies suggest that, patients who chewed sugarless gum sweetened with xylitol reduced their risk of developing an ear infection by more than a third.

Herbal ear drops (Calendula officinalis, Hypericum perfoliatum, Verbascum thapsus, Allium sativum) – A few studies suggest that ear drops containing calendula, mullein, St. John’s wort, and garlic were as effective at relieving pain as prescription ear drops.

Belladonna, as a homeopathic medicine — In one study, children who took a homeopathic preparation of belladonna had fewer ear infections, and the ones they got didn’t last as long as children who took antibiotics.

Echinacea (Echinacea purpurea) – Although it has not been studied for ear infections, some doctors may suggest echinacea to help prevent recurring ear infections.

Bee propolis – Studies provide the efficacy of a propolis and zinc suspension in preventing AOM.

Reference –











February 3, 2017

Acoustic neuromas, also known as “acoustics” or vestibular schwannomas is a benign, usually slow-growing tumor that develops from the balance and hearing nerves supplying the inner ear.

It is a tumor that grows from the nerves responsible for balance and hearing. More accurately called vestibular schwannoma, these tumors grow from the sheath covering the vestibulocochlear nerve. Acoustic neuromas are benign (not cancerous) and usually grow slowly. Over time the tumor can cause gradual hearing loss, ringing in the ear, and dizziness. Because of their slow growth, not all acoustic neuromas need to be treated. Treatment options include observation, surgery, and radiation.

The inner ear – The inner ear is an organ of hearing and balance. Sound waves vibrate the eardrum located in the middle ear. Three tiny bones (the incus, malleus and stapes) on the other side of the eardrum pick up the vibration and deliver it to a small organ called the cochlea, located in the inner ear. The vibration is translated into electrical impulses and passed onto the brain via the cochlear nerve.

The sense organ of balance is also located inside the inner ear. A series of fluid-filled canals, set at different angles, help the brain to pinpoint movement. As the head is moved, the fluid rolls around inside the canals and is monitored by tiny hairs. The information on the head’s position is then relayed to the brain via the vestibular nerve, which lies alongside the cochlear nerve.

An acoustic neuroma, or vestibular schwannoma, is a benign, slow-growing tumor that arises from the Schwann cells forming the sheath (covering) of the vestibulocochlear nerve. As the tumor grows, it expands from its origin inside the internal auditory canal out into the space between the brainstem and the temporal bone known as the cerebellopontine angle. The pear-shaped tumor can continue to enlarge, compressing the trigeminal nerve, which is responsible for facial sensation. Eventually, the tumor can compress the brainstem. Acoustic neuromas are classified according to their size as small (less than 1.5 cm), medium (1.5 to 2.5 cm), or large (more than 2.5 cm).

They are uncommon, and occur in approximately 10 people per million per year in the United States.They tend to be found in patients older than 40 years. The vast majority (95%) of these tumors are sporadic, meaning they are not passed on through genes. Sporatic tumors occur in only one ear, and there are no known risk factors. Rarely these tumors are associated with a genetic disease called Neurofibromatosis Type II. Patients with Neurofibromatosis develop tumors at a younger age, usually have tumors on both sides and also have other manifestations, including benign tumors of the brain and dura (the covering of the brain).


In most cases, the cause of an acoustic neuroma is unknown.

The only known risk factor for developing an acoustic neuroma is having a rare genetic condition called neurofibromatosis type 2. Acoustic neuromas grow from the Schwann cells lining the vestibulocochlear nerve, which is why they are sometimes called vestibular schwannomas. Schwann cells form a sheath around nerves, helping electrical signals to travel through the body.

It’s also not known what causes some acoustic neuromas to start growing or continue growing while others remain the same size.


A small acoustic neuroma may cause no symptoms. If you do have symptoms from an acoustic neuroma, these usually develop very gradually, as the tumour is slow-growing. The symptoms that an acoustic neuroma can cause are very common. Remember that acoustic neuromas are very rare. You should see your doctor if you have any of these symptoms, but they are more likely to be due to other conditions than a brain tumour.

The most common symptoms of an acoustic neuroma are –

Hearing loss – Some degree of deafness occurs in most people with an acoustic neuroma. Usually hearing loss is gradual and affects one ear. The type of deafness caused is called sensorineural deafness and means the nerve for hearing (the acoustic nerve) is damaged.

Tinnitus – This is the medical name for ringing in the ears. About 7 in 10 people with an acoustic neuroma have tinnitus in one ear. The sounds can vary; it does not have to be ringing like a bell. Tinnitus describes any sounds heard within the ear when there is no external sound being made. Tinnitus is a common symptom and not a disease in itself. Other causes of tinnitus include earwax, ear infections, ageing and noise-induced hearing loss.

Vertigo – This is the sensation of the room spinning, often described as dizziness. It is not a fear of heights as some people incorrectly think. This feeling of movement occurs even when you are standing still. Vertigo can be caused by other conditions affecting the inner ear. Nearly half of people with an acoustic neuroma have this symptom, but less than 1 in 10 have it as their first symptom.

Loss of feeling (facial numbness), tingling or pain – These symptoms are due to pressure from the acoustic neuroma on other nerves. The commonly affected nerve is called the trigeminal nerve which controls feeling in the face. About 1 in 4 people with acoustic neuroma have some facial numbness – this is a more common symptom than weakness of the facial muscles.

Headache – This is a relatively rare symptom of an acoustic neuroma. It can occur if the tumour is big enough to block the flow of cerebrospinal fluid in the brain. Cerebrospinal fluid is the clear, nourishing fluid that flows around the brain and spinal cord, protecting the delicate structures from physical and chemical harm. Obstruction to the flow and drainage of cerebrospinal fluid can cause a problem known as ‘water on the brain’ (hydrocephalus).

Earache – This is another rare symptom of acoustic neuroma. There are many more common causes of earache.

Visual problems – Again, these are a rare symptom. If they do happen, it is due to hydrocephalus (see above).

Tiredness and lack of energy – These are nonspecific symptoms and can be due to many causes. It is possible that a non-cancerous (benign) brain tumour could lead to this.


For small tumours, doctors may recommend no action at all, apart from regular checking. This is because an acoustic neuroma typically grows at a slow rate in the initial stages. However, often treatment is required.

Options may include –

  • Surgery – microsurgery techniques are used to remove the tumour. However, side effects can include loss of hearing and facial nerve damage. The choice of surgical approach depends on the size and location of the tumor and the degree of hearing loss. In some cases, it is possible to save hearing. With larger tumors, hearing must be sacrificed in order to successfully remove the entire tumor. Total removal of the tumor without complications is the surgical goal.
  • Stereotactic procedure – is a non-invasive treatment that directs gamma radiation at the tumour. Side effects may also be experienced with this procedure. Stereotactic radiation therapy (commonly called, radiosurgery) is a term used to describe several specific radiation techniques including Gamma Knife Surgery, LINAC, and fractionated radiosurgery, depending on the type of radiation beam and type of machinery used Stereotactic radiotherapy is a method of delivering a radiation dose in such a way as to minimize the dose of radiation to surrounding normal tissues (brain) while delivering a very high dose to the tumor.

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