Acoustic Neuroma

In this blog you will learn about acoustic neuroma, signs, symptoms, causes, risk factors, and physical therapy treatment to improve balance, prevent falls, and increase quality of life. 

Acoustic neuroma is a benign tumor that grows very slowly (1-2.3 mm/year) in the brain and put s pressure on balance and hearing nerves, affecting the hearing, balance, coordination, mobility, and gait. 

Acoustic neuroma is a very rare condition that affects 1 in every 100,000 people according to the National Organization of Rare Diseases . The acoustic neuroma tends to be unilateral in most cases and affects people between the fourth and sixth decade of life.

Half of acoustic neuroma tends to shrink with time according to resent research. 

Sign and Symptoms

  • Gradual Hearing loss in one ear (initial symptom in approximately 90% of cases) .
  • Ringing sound in one ear.
  • Loss of balance.
  • Dizziness ( dizziness tends to decrease as the size of the tumor increases ). 
  • Unsteady gait.
  • Loss of coordination.
  • Facial numbness and tingling.
  • Instability while moving the head.
  • Fatigue.
  • Head and neck pain.
  • Feeling Off Balance.
  • Veering to the side when walking.
  • Clumsy walk.

Causes

Acoustic neuroma is caused by:

  1. A defective gene on the chromosome 22q12.2. A healthy gene of the chromosome releases a suppressor protein that controls the growth of this type of tumor. 
  2. Neck and face radiation exposure predispose the patient to develop acoustic neuroma.

Risk Factors

  • Constant exposure to loud noises
  • Cellphone use

What Physical Therapy Can Do:

Physical therapy can treat the dizziness, imbalance, unsteady gait, and weakness in facial muscles before or/and after surgery. In addition, post-surgery physical therapy focuses on improving balance, gait ability, facial muscle strength, and fall prevention. 
Physical Therapy designs a customized rehabilitation program after performing a detail assessment that includes:

Functional mobility assessment that include getting up from bed, transferring from a chair, and vice versa. 

Gait assess difficulty walking, imbalance, or unsteady gait while turning the head during walking. 

Range of motion in the neck as follows: looking up, looking down, looking over the shoulder, and turning head to reach shoulder with the ear.

Equilibrium reactions in hips and ankles with moving the body forward and backward and seeing the postural reactions to the change of movement.

Muscle strength assess facial muscle expressions, arms, and leg strength.

Test for Vertigo as follow:

  • Long sitting on bed or table
  • Turn head to look over the shoulder (about 45 degrees of rotations), and slowly rest on the back with head hanging off edge of the table.
  • Count 45 seconds and then slowly sit up.
  • Repeat turning the head to the other side. 
  • If the patient experiences spinning of the room while doing the movement, the test is positive. 

Cranial Nerve Function/Assessment:

  • I-Olfactory assess the ability to smell.
  • II-Optic assess vision
  • III-Oculomotor assess eye movement, and pupil contractions.
  • IV-Trochlear assess eye movement.
  • V-Trigeminal asses corneal reflexes, jaw movements, and facial sensation.
  • VI-Abducens assess eye movement.
  • VII-Facial assess facial movement (smiling, lifting eyebrow, frowning, showing teeth, feeling cheeks with air, and closing the eyes tight.
  • VIII-Vestibulocochlear assess the ability to hear.
  • IX-Glossopharyngeal assess swallowing.
  • X-Vagus assess the gag reflex.
  • XI- Spinal Accessory assess neck and shoulder movements.
  • XII-Hypoglossal assess the position of the tongue and symmetry. 

Cranial Nerves

The cranial nerves are 12 pairs of nerves that originate in the brain and innervated the head, neck, and trunk. 

The cranial nerves have three main functions sensory, motor, and parasympathetic function. 

Sensory cranial nerves are responsible for the sense of smell, hearing, seeing, tasting, and feeling. 

Motor cranial nerves are responsible of controlling the movement, and coordination.

Parasympathetic cranial nerves activate the relaxation response in the heart, lungs, and visceras. 

How Physical Therapy Can Help?

The goal of physical therapy is helping the patient to improve posture stability, balance, improve daily living activities, enhance gaze stability, prevent falls, and improve gait.

Physical Therapy Treatments

Romberg exercises are balance exercises to improve balance and reduce the risk of falls.

Standing with feet together-eyes opened-shoes on

Stand with a wall behind the back and a chair in front of you (for support and safety).

Put feet together and arms to the side.

If this is too difficult, put one hand on the chair for support and safety.

Hold this position for 30 seconds, repeat twice a day.

Standing with feet together with eyes opened, shoes off

Stand with a wall behind the back and a chair in front of you (for support and safety)..

Put feet together and arms to the side.

If this is too difficult, put one hand on the chair for support and safety.

Hold this position for 30 seconds, repeat twice a day

Progress with eyes closed when the previous exercise become easier. 

Standing with feet together with eyes closed, shoes on

Stand with a wall behind the back and a chair in front of you (for support and safety).

Put feet together and arms to the side.

If this is too difficult, put one hand on the chair for support and safety.

Hold this position for 30 seconds, repeat twice a day.

Standing with feet together with eyes closed, shoes off

Stand with a wall behind the back and a chair in front of you (for support and safety).

Put feet together and arms to the side.

If this is too difficult, put one hand on the chair for support and safety.

Hold this position for 30 seconds, repeat twice a day.

Standing with feet together sway forward and backward exercise

Stand with a wall behind the back and a chair in front of you (for support and safety).

Standing with feet together.

Bend the trunk forward and move the hip backward with the toes up.

Bend the trunk backward and move the hip forward with the heels up.

Repeat several times.

Improving dizziness with gaze stability exercises-eyes opened

Sit in a comfortable chair in front of a table in a bright light room.

Put an attractive object in front, on top of the table.

Make sure the eyes are aligned with the object.

Keep looking at the object while turning the head to the right and left.

Keep looking at the object while moving the head up and down.

Do these exercises four to five times a day for 20-40 minutes/day.

Improving dizziness with gaze stability exercises-eyes closed

Look at the object in front of you, eye level.

Closed the eyes and slowly turn the head, while imagining you are still looking at the object.

Open the eyes and see if the eyes are still looking at the object. Adjust the eyes and repeat.

Improving Gait

Stand with a wall behind the back and a chair in front of you (for support and safety).

March in place for 20 repetitions, twice a day. 

Try to march in place with eyes closed

Gait training with appropriate assistive device as needed.

Strengthening weak muscles of the face

Gentle Stretches and strengthening exercises with manual resistance.

Modalities to facilitate muscle contraction

Electrical stimulation to facilitated muscle contraction in facial muscles.

If you are dealing with balance issues, or you want to be more active and you don’t know how to start, call now to find out how Physical Therapy can help you recover faster, move easier, and freer: 

Call Dr. Alexandra Chaux:  805-203-9940

The information in this blog is for educational and informational purpose only, its content is provided based upon evidence-based physical therapy research, knowledge, and experience as a Doctor of Physical Therapy (DPT).