There are several different treatment options for an acoustic neuroma. Which treatment you have will depend on a number of factors, including:

• your age
• your overall health
• the size and position of your tumour

The results of any tests or scans you have had will also help to determine the best course of treatment. Your acoustic neuroma will usually be treated by a team of specialists and other health professionals including:

• a neurosurgeon - a surgeon who specialises in operating on the nervous system (brain, spinal cord and nerves)
• an ear, nose and throat (ENT) surgeon - a surgeon who specialises in operating on conditions that affect the ears, nose or throat
• a neurologist - a doctor who specialises in diagnosing and treating conditions that affect the brain and nervous system; for example, by deciding which tests are necessary and prescribing medication 
• an oncologist - a doctor who specialises in cancer and tumours; for example, using radiotherapy (controlled doses of high-energy radiation) to treat benign (non-cancerous) tumours, such as acoustic neuromas

Monitoring

If your acoustic neuroma is very small or growing very slowly, you may be advised not to have any immediate treatment. Instead, your condition will be monitored. Some research has suggested that as many as three-quarters of acoustic neuromas do not appear to be growing, so monitoring the tumour (growth) is all that is needed.

Although simply monitoring your acoustic neuroma may seem like nothing is being done about your condition, it can be the best option because the risks associated with surgery or radiotherapy (see below) outweigh the risk of an acoustic neuroma affecting your health.

To help monitor your condition you will need to have regular magnetic resonance imaging (MRI) scans (where a magnetic field and radio waves are used to create an image of the inside of your body). The MRI scan will check the size and growth of your acoustic neuroma. Other treatments may be considered if the tumour:

• shows any signs of growing
• significantly affects your health

See the Health A-Z topic about MRI scans for more information about this procedure. You may need to have an MRI scan every one or two years, although this will depend on your general health and the severity of your tumour.

Microsurgery

Acoustic neuromas can be treated using microsurgery to remove the tumour. The surgery is carried out under general anaesthetic (a painkilling medication that makes you unconscious), and the acoustic neuroma is removed through an incision (cut) that is made in your skull.

In most cases, the acoustic neuroma can be completely removed, although in rare cases a small part of the tumour may be left behind. This may be necessary to minimise the risk of causing nerve damage. In cases where a small part of the tumour remains, it can usually be effectively treated using radiotherapy (see below).

Hearing loss

After acoustic neuroma surgery, many people find that their hearing is permanently affected to some degree. Usually, your neurosurgeon works alongside a hearing surgeon during your operation to minimise the risk of your hearing being affected.

In most cases, the larger your acoustic neuroma the greater the risk that your hearing will be affected. If your tumour is more than 1.5cm (0.6 inches) in diameter, you will almost certainly have permanent hearing loss after the surgery.

If your hearing is affected, it will usually only be affected in one ear. If this is the case, after surgery, you may be able to be fitted with a hearing aid which will help to divert sound from your affected ear to your good ear.

If your acoustic neuroma is caused by neurofibromatosis type 2, and the tumour has grown on both sides of your acoustic nerve, there is a strong likelihood that, after surgery, you will completely lose the hearing in both of your ears. For this reason, surgery for a tumour on both sides of the acoustic nerve will usually be delayed for as long as possible. Surgery will only be performed if the acoustic neuroma significantly affects the rest of your health.

See the Health A-Z topic about Hearing impairment - treatment for more information about treating hearing loss.

Facial nerve

Occasionally, surgery can damage the facial nerve. This is because the acoustic nerve is very close to the facial nerve. Your surgeon will try very hard not to damage your facial nerve, but sometimes damage is unavoidable, particularly in cases where the acoustic neuroma is large.

If your facial nerve is damaged during surgery you may find that:

• your speech is no longer as clear
• you have problems swallowing (dysphagia)
• you have a droop on one side of your face (facial palsy)

These symptoms may improve with physiotherapy (where physical methods, such as massage and manipulation, are used to promote healing and wellbeing). However, it is important to be aware that some damage to your facial nerve may be permanent.

Damage to your facial nerve can also affect your eyes - for example you may have difficulty blinking or completely closing your eye on the side that was operated on. This may lead to your eyes drying out.

For people with tumours that are smaller than 1.5cm (0.6 inches) across, less than 1 person in every 10 will have their facial nerve badly affected after treatment.

For people with tumours of more than 2.5cm (1 inch) across, around 2 in 10 people will have facial nerve weakness after surgery. Facial nerve weakness is likely to be temporary, but it may take several months to recover. About two-thirds of people with tumours that are 4-5cm (1.6-2 inches) across have the function of their facial nerve fully restored following surgery.

Recovery from surgery

Following surgery, you will usually need to spend four to five days in hospital. A small number of people experience severe headaches after surgery. These can be managed with medication and should improve with time. 

You should be able to return to work after around three months. However, a complete recovery may take longer than this. For example, your facial nerve may still be improving up to 18 months after your operation.

The length of time that it takes you to recover may depend on the size and position of the tumour that was removed. The healthcare professionals treating you will be able to advise you. 

If your acoustic neuroma was completely removed, you will not usually require further treatment.

Radiotherapy

Radiotherapy uses safe and controlled doses of radiation (waves of energy) to treat conditions such as tumours and cancer. Radiotherapy cannot always destroy a tumour completely, but it often helps to shrink it and slow down its growth.

If a very small amount of tumour is left on your acoustic nerve after surgery, radiotherapy may be used to treat the tumour.

See the Health A-Z topic about Radiotherapy for more information about this type of treatment.

Radiotherapy can be focused directly on your acoustic neuroma to minimise the damage to healthy surrounding tissue. Depending on the type of radiotherapy that you have, you may need a number of radiotherapy sessions.

Stereotactic radiosurgery

Stereotactic radiosurgery is a newer type of treatment that delivers a very precise dose of radiation to your acoustic neuroma. Stereotactic means locating a point (in this case the position of the tumour in your brain), using three-dimensional coordinates. 

Stereotactic radiosurgery ensures that the maximum amount of radiation is aimed at your tumour and that surrounding tissue is not exposed. It may be given as a single dose or delivered over several sessions.

Stereotactic radiosurgery is performed under local anaesthetic, which means that you will be conscious throughout the procedure but your scalp will be numbed. A lightweight frame is attached to your scalp, and a series of scans accurately pinpoint the position of the tumour. This can then be treated using a precise beam of radiotherapy.

Side effects of stereotactic radiosurgery can include:

• nausea (feeling sick)
• neck stiffness

Nerve damage

In some cases, stereotactic radiosurgery can cause nerve damage, although this may be delayed for several weeks or months after treatment. 

Symptoms of nerve damage can include:

• facial numbness (loss of feeling)
• facial paralysis (not being able to move part of your face)
• hearing loss

Facial paralysis may affect 2 or 3 people in every 100 who have stereotactic radiosurgery. It is estimated that just under a third of people may have hearing loss after stereotactic radiosurgery. 

There may be slightly fewer complications when stereotactic radiosurgery is performed over several sessions rather than in a single session.

Auditory brain stem implants

If your acoustic neuroma is caused by neurofibromatosis type 2 (a rare inherited condition, see Acoustic neuroma - causes) it may be possible to have auditory brain stem implants. These are tiny electrical devices that are inserted into your brain stem (the lower part of the brain that is connected to the spinal cord).

Auditory brain stem implants can be fitted at the same time as surgery to remove your acoustic neuroma. For people who are likely to have complete hearing loss, auditory brain stem implants may enable them to hear some sounds.

This type of treatment is sometimes only available in some specialist centres.