Do you keep reading that an acoustic neuroma “can be fatal”?

Is this scaring the daylights out of you, especially since your tinnitus has not yet been evaluated?

It’s true that an acoustic neuroma can lead to death. However, in this era of modern medicine, a lethal acoustic neuroma is more hypothetical than reality.

The key words are “left untreated.”

So you’re probably thinking, “Who doesn’t get their acoustic neuroma treated? The symptoms as the tumor grows eventually cannot be ignored.”

“And why do so many medical sites say that an acoustic neuroma can be fatal”?

An even more compelling question is: Can an acoustic neuroma kill a person before it starts causing symptoms?

Why an Acoustic Neuroma Can Be Fatal

“Prior to modern medical imaging, fatality from these tumors was not uncommon,” explains Brandon Isaacson, MD, F.A.C.S., Department of Otolaryngology – Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX.

“In this day and age it is quite rare [dying from an acoustic neuroma] except in patients with no access to medical care,” says Dr. Isaacson.

“Death from a large acoustic neuroma occurs secondary to obstructive hydrocephalus (spinal fluid has no way to exit the ventricular system within the brain). This causes the brain to protrude through the base of the skull.

“Other mechanisms for fatality include having a stroke or a heart attack during or after surgery (<1%), or developing a cancerous tumor after radiation (1:1000).”

The 1:1000 refers to malignant transformation, not mortality.

Medical sites need to be fair. This is why it’s proper for them to state that an acoustic neuroma CAN be fatal. This statement, as accurate as it is, cannot be used as a predictor for survival.

That’s because in a realistic setting, these tumors DO get treated. It’s very difficult, even for someone without medical insurance, to ignore the symptoms.

Symptoms

Progressive hearing loss

Tinnitus that can be quite troubling

Facial paralysis

Balance problems

Headaches that won’t go away.

Even a mentally ill shut-in with no family or friends will likely eventually seek out a doctor for these symptoms as they become unbearable.

Of course, someone who lives in a remote area of a developing country who develops these symptoms may never see a doctor – and hence, die from their acoustic neuroma.

Nevertheless, people in industrial nations have died as a result of their acoustic neuroma.

But this mortality is related to surgery. The larger the tumor the higher the mortality rate following surgery. Causes of death, due to surgical complications, may also be from:

• Softening of the outer side of the pons, a part of the brainstem involved in critical functions including breathing.

• Bleeding blood vessel in the pons.

• And as mentioned, malignant transformation of the tumor years after radiation surgery. Radiosurgery doesn’t remove the tumor; it either shrinks it or stops it from growing.

Malignant transformation of the residual mass is EXTREMELY rare – just a handful of cases reported in medical literature.

In summary, an acoustic neuroma will likely become fatal if left untreated.

It’s not realistic that it will grow larger than a ping pong ball without producing any symptoms.

When a treated acoustic neuroma leads to death, this is due to a rare complication of surgery.

Dr. Isaacson’sdr. isaacson research interests include cochlear implants, endoscopic ear surgery and acoustic neuroma. His clinical interests include all aspects of otology and neurotology, with a special focus on skull base surgery.
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Top image: Blausen.com
Source: thejns.org/doi/abs/10.3171/jns.1967.26.1part1.0006?journalCode=jns