Rehabilitation after Acoustic Neuroma Surgery

by Joon Nah   BScPT
Certified Vestibular Physiotherapist
updated Aug 8, 2022

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What is an Acoustic Neuroma?

An acoustic neuroma (also called a vestibular schwannoma) is a non malignant, slow-growing tumor affecting the cochlear and vestibular nerve. This nerve helps your head sense motion and position as well as transmitting sound information to your brain. The tumor is typically a result of an abnormal growth of the insulation (schwann cells) that surround the vestibular-cochlear nerve. If these brain tumors grow unchecked, it can not only result in problems with balance and hearing, but can compress other areas of the brain potentially causing a variety of serious brain-related symptoms.

 

What are symptoms of an Acoustic Neuroma?

The following are the most common symptoms of an acoustic neuroma. However you may not experience all of them, and the order in which they appear can vary.

• Tinnitus (ringing sound) on one side of your head
• Progressive hearing loss of one ear
• Dizziness
• Imbalance
• Difficulty walking
• Motion sensitivity
• Facial weakness

 

What is the treatment for an Acoustic Neuroma?

1)  Wait and See Approach

As it sounds, patients will simply monitor their symptoms and look for changes over time. You will have regular appointments with your neurologist or otolaryngologist to determine if your symptoms are worsening or stable. This usually involves annual or regular head scans or imaging such as a CT scan or MRI.

This approach is taken when the tumor is small and the symptoms are minor. Acoustic neuromas usually grow very slowly or not at all; in fact up to half of all acoustic neuromas are treated in this way.

2)  Medications

There are conflicting research studies regarding the use of medications to reduce the growth of acoustic neuromas. At this time, it’s not considered a mainline or conventional treatment and whether it does will depend on the results of future research. However there are some patients who do attempt this method of tumor reduction.

3)  Surgery

When symptoms are worsening and the tumor is larger in size, surgery is usually recommended. Here the acoustic neuroma is physically removed, typically through opening a window in your skull or through the inner ear.

4)  Radiation therapy or Gamma knife radiosurgery

This common treatment method uses gamma rays to target the tumor from different directions, all intersecting on the neuroma. There are other types of radiation used, but gamma knife is the oldest and most common type, used for most patients.

 

Symptoms following acoustic neuroma surgery

It is common to experience symptoms following surgery or radiation treatment. Most of the stronger, acute symptoms will reduce within the first few days following surgery. If the symptoms continue beyond this initial recovery period, then rehabilitation is required to further improve your symptoms.

The following are the most common symptoms following vestibular schwannoma radiation or surgery.

• Nausea
• Dizziness
• Imbalance
• Headache pain
• Neck pain and stiffness
• Hearing loss or tinnitus
• One-sided facial numbness, difficulty speaking and chewing
• Intermittent swelling around the incision site
• Numbness at the incision that can last for months

 

Rehabilitation after surgery for Acoustic Neuroma

NOTE: Each surgeon and every hospital have developed their own post-operative protocols. The information contained in this article may not apply to your specific circumstance and you should always consult with your specialist first.

Most patients will require some form of rehabilitation following their procedure. The tumor itself may have slowly caused damage to structures in the brain as it has grown over time. Additionally, the removal of the tumor itself comes with side-effects that can create damage to the vestibular and cochlear nerve. This can lead to increased balance and hearing-related symptoms. Note that damage may occur to other areas of the brain (e.g. facial nerve, visual system).

Here are common treatment options for ongoing symptoms following surgery.

Vestibular Rehabilitation

Vestibular rehabilitation is delivered by physiotherapists specialized in the assessment and treatment of dizziness and balance disorders. Balance is almost always worse following surgical and radiation treatment and patients will generally require vestibular rehabilitation. Research indicates that introducing vestibular rehabilitation soon after surgery for acoustic neuroma (within 6 weeks) improves vestibular symptoms, in the short and long term.

Patients are commonly recommended to undergo a few sessions of vestibular physiotherapy prior to their surgery or radiation treatment. This “primes” or proactively prepares the vestibular system to more easily and quickly adapt to the vestibular rehabilitation treatment that is typically required following surgery/radiation.

Read further below for details on vestibular rehabilitation.

Walking

Daily walking can have a tremendous impact on your recovery. Start with short frequent walks e.g. 10-15 minutes 3x daily. Keep it slow so that your heart rate doesn’t increase significantly. Then as you feel better, gradually increase the duration of your walks as you reduce the frequency to once a day.

Other physical activity

Generally, movement based activities are excellent ways to stimulate your brain to recover. However, for the first few weeks following surgery, use caution with any activities that cause you to strain e.g. heavy lifting or bearing down hard during bowel movements.

Avoid heart-rate elevating activities like running, biking and aerobics for at least 6 weeks following your surgery.

Hearing Rehabilitation

Some patients may continue to experience the hearing issues they were affected by prior to the procedure, or may develop new ohearing symptoms afterwards. A hearing test will determine whether hearing aids or other interventions may be required to address hearing loss or tinnitus.

Speech-Language Therapy

For the small minority of patients that experience side-effects impacting facial muscles and the muscles of the mouth following surgery, a speech-language therapist can help with your recovery. You will be given exercises to normalize your speech function and be shown strategies to compensate for any disabilities.

 

How does vestibular physiotherapy work after acoustic neuroma surgery?

Physical Therapy Assessment

Everyone’s symptoms are different as the acoustic neuroma can grow in different ways and at different rates. Additionally, each patient can compensate to their impairments differently as well. This means that a detailed assessment will be required to ensure that any treatment recommendations are best for your unique situation.

A skilled vestibular physiotherapist will take a thorough history of your problem, including your symptoms, how they have progressed over time and how they are affecting your activities of daily living. Your physical therapist will then perform testing to identify details of your condition and measure their impact on your function. This can include manual neurological tests, balance and gait assessment, and infrared goggle testing to look at eye nystagmus (eye reflexes that can clarify vestibular issues).

Your vestibular physiotherapist will then discuss their findings and make recommendations on how you can improve your recovery.

Physical Therapy Treatment

Vestibular rehabilitation therapy will typically involve the following:

• Education on your condition and strategies to help you minimize the impact it has on your life
• Vestibular exercises prescribed to address impairments specific to you
• Follow up visits to reassess your condition and to change or progress your home exercise program

Click here to learn more about vestibular rehabilitation.

 

How long will I have symptoms following my acoustic neuroma surgery or radiation?

If you don’t have any complications related to your procedure, you should have a full resolution of your symptoms by the one year mark.

 

How long does dizziness last after acoustic neuroma surgery?

The length of dizziness symptoms is highly variable. It can be just a few weeks or can be a permanent side-effect of the procedure.  It depends on how large and invasive the tumor is, the specific procedure used, and whether you participated in vestibular rehabilitation.

 

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The Cornerstone Dizziness Clinic has vestibular physiotherapists who are skilled in the treatment of dizziness and balance related conditions. We have locations in Toronto, North York, Burlington and Markham. We also offer a free 10 minute phone consultation if you are unsure whether we can help you. Contact us today and let us help you with your vestibular symptoms.

 

References

Luc Vereeck 1, Floris L Wuyts, Steven Truijen, Claudia De Valck, Paul H Van de Heyning  The effect of early customized vestibular rehabilitation on balance after acoustic neuroma resection.  Randomized Controlled Trial Clin Rehabil 2008 Aug;22(8):698-713.

Levo H, Blomstedt G, Pyykko I. Postural stability after vestibular schwannoma surgery. Ann Otol Rhinol Laryngol 2004;113:994-9.

Tufarelli D, Meli A, Labini FS, Badaracco C, De Angelis E, Alesii A, Falcioni M, Sanna M. Balance impairment after acoustic neuroma surgery. Otol Neurotol. 2007 Sep;28(6):814-21.

Silvie Hrubá, Martin Chovanec, Zdeněk Čada, Zuzana Balatková, Zdeněk Fík, Kryštof Slabý, Eduard Zvěřina, Jan Betka, Jan Plzak, Ondřej Čakrt  The evaluation of vestibular compensation by vestibular rehabilitation and prehabilitation in short-term postsurgical period in patients following surgical treatment of vestibular schwannoma

Eur Arch Otorhinolaryngol. 2019 Oct;276(10):2681-2689.

B Müller, G F Volk, O Guntinas-Lichius  Rehabilitation of facial palsy and vertigo in patients with vestibular schwannoma.  HNO.  2017 Sep;65(9):724-734.