Tinnitus: Questions About Acoustic Neuroma and Diagnosis

Tinnitus Consultation

I have been experiencing high-frequency tinnitus for over a year.
Initially, I went to a large hospital for a pure tone audiometry test, which came back normal with no abnormalities.
The ENT specialist advised me to relax and did not prescribe any medication, so I went home.
While researching online, I came across information suggesting that acoustic neuromas can also cause tinnitus.
I would like to know if the tinnitus associated with this condition is typically low-frequency or high-frequency.
If I visit a neurologist, considering that I only have tinnitus without any other complications, what tests will the doctor perform to determine if there is an acoustic neuroma? A head X-ray likely wouldn't show anything, right? Would a doctor be willing to order an MRI or CT scan for me? Recently, I have managed to reduce the volume of my tinnitus through mood adjustment and exercise.
I just want to know if there is something concerning in my brain.
If not, I will try to be more at ease or consider some alternative therapies (like acupuncture injections).
Thank you, doctor!

A-Hong, 20~29 year old female. Ask Date: 2013/05/02

Dr. Gao Chunde reply Neurology

Acoustic neuromas can indeed cause tinnitus, and otolaryngologists and neurologists have a more sensitive test than CT and MRI, which is the brainstem auditory evoked potentials (BAEP).
If you still have concerns, these specialists should be able to address your worries using this test.

Reply Date: 2013/05/02

More Info

Acoustic neuroma, also known as vestibular schwannoma, is a benign tumor that develops on the vestibulocochlear nerve (the eighth cranial nerve), which is responsible for hearing and balance. This condition can lead to various symptoms, including hearing loss, tinnitus (ear ringing), and balance issues. Understanding the nature of this tumor, its incidence, and treatment options is crucial for anyone experiencing related symptoms.

Understanding Acoustic Neuroma
Medical Terminology and Incidence:
The medical term for acoustic neuroma is "vestibular schwannoma." It is relatively rare, with an estimated incidence of about 1 in 100,000 people per year. Most commonly, it occurs in adults between the ages of 30 and 60, but it can also affect younger individuals. The exact cause of acoustic neuroma is not well understood, although it is associated with a genetic disorder known as Neurofibromatosis Type II (NF2), which can lead to the development of bilateral tumors.

Symptoms:
The symptoms of acoustic neuroma can vary widely among individuals. The most common symptoms include:
- Hearing Loss: Often gradual and may affect one ear more than the other.

- Tinnitus: This can manifest as ringing, buzzing, or hissing sounds in the ear. The frequency of the tinnitus can vary; some patients report high-pitched sounds, while others may experience low-frequency sounds.

- Balance Issues: As the tumor grows, it can affect balance, leading to dizziness or unsteadiness.

Diagnosis and Evaluation
If you are experiencing persistent tinnitus, especially if it has been ongoing for over a year, it is advisable to seek further evaluation. While a normal hearing test is reassuring, it does not completely rule out the presence of an acoustic neuroma.
Diagnostic Imaging:
To assess for the presence of an acoustic neuroma, imaging studies are typically required. The most common imaging modalities include:
- MRI (Magnetic Resonance Imaging): This is the preferred method for diagnosing acoustic neuroma, as it provides detailed images of soft tissues, including the brain and nerves. An MRI can effectively visualize the tumor and assess its size and location.

- CT (Computed Tomography): While CT scans can be useful, they are less sensitive than MRI for detecting small tumors. However, they may be used in certain situations, especially if MRI is contraindicated.

Referral to Specialists:
If you are concerned about the possibility of an acoustic neuroma, it is advisable to consult with an otolaryngologist (ear, nose, and throat specialist) or a neurologist. They can evaluate your symptoms and determine the need for imaging studies. If you only have tinnitus without other neurological symptoms, the physician may still consider imaging based on your history and the characteristics of your tinnitus.

Treatment Options
If an acoustic neuroma is diagnosed, treatment options may vary based on the size of the tumor, the severity of symptoms, and the patient's overall health. Common treatment approaches include:
- Observation: For small tumors that are not causing significant symptoms, a "watchful waiting" approach may be recommended, with regular monitoring through MRI.

- Surgery: If the tumor is large or causing significant symptoms, surgical removal may be necessary. The type of surgery will depend on the tumor's size and location.

- Radiation Therapy: Stereotactic radiosurgery (such as Gamma Knife) may be an option for patients who are not candidates for surgery or prefer a non-invasive approach.

Conclusion
In summary, while your experience of high-frequency tinnitus is not uncommon, it is essential to remain vigilant and consult with healthcare professionals if symptoms persist or worsen. Acoustic neuroma is a possibility, but it is only one of many potential causes of tinnitus. Diagnostic imaging, particularly MRI, is crucial for a definitive diagnosis. If you have concerns about your health, do not hesitate to seek further evaluation and discuss your options with your healthcare provider. Remember, managing stress and maintaining a healthy lifestyle can also contribute positively to your overall well-being.

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