Medical Management

Medical treatment

   Medical management of acoustic neuromas consists of periodic monitoring of the patients neurological status, use of hearing aids when appropriate and periodic imaging studies such as magnetic resonance imaging of the brain with contrast. Watchful waiting is felt to be appropriate in many patients with slow-growing tumors. No medication is known to have a substantial effect on the growth of acoustic neuroma tumors. Tumors often grow very slowly at 1 ½ millimeter per year.
    Medical Management may be elected when a serious threat to life or bodily function from an acoustic neuroma may be judged unlikely in the remainder of the patient’s expected life span. When a tumor is diagnosed, a repeat scan should be obtained at three months, six months, or yearly depending on the size of the tumor and it’s risk of growth.
     A recent study of watchful waiting found that patients did surprising well.

Tos T, Caye-Thomasen P, Stangerup SE, Tos M, Thomsen J.: Long-term socio-economic impact of vestibular schwannoma for patients under observation and after surgery. J Laryngol Otol. 2003 Dec;117(12):955-64.

The above study compared the long-term socio-economic impact for patients either operated on or observed during the period 1976-2000. The study says that: "34 per cent of operated patients resumed their daily activities within one to two months, and 76 per cent within four to six months. Patients operated on for a large tumor resumed their daily activities later than patients with a small tumor. Regardless of tumor size, employment was unchanged for the majority of observed and operated patients. The vocational consequences were significantly worse for operated patients with a large tumor, than for observed patients. However, no difference existed between the observed group and operated patients with a tumor below 20 mm in size. A change in vocational status was most frequent for assisting spouses, unskilled manual workers and the self-employed. The majority of both observed and operated patients experienced no change in their ability to handle daily chores. The changed ability of operated patients was worse than that of observed patients. Among various changes in their psycho-social well-being, decrease in social ability was the most frequent complaint in both groups, followed by increased fatigue, decreased concentration, increased irritability, depression and headache, decreased intellect and libido. Regardless of tumor size, the change in social ability, concentration and fatigue was worse for operated patients. Concerning headache, patients operated on for a large tumor were better off than observed patients and patients operated on for a small tumor. There was no difference between the operated and observed groups concerning irritability, intellect and libido. Deterioration of vocational status, ability to handle daily chores and several aspects of psycho-social well-being are reported both by patients operated on and observed for vestibular schwannoma. However, the negative changes were more frequent among the operated patients, although the differences were surprisingly modest, especially when comparing observed patients with patients operated on for a small tumor."

Orginal essay by Maria Auren Bernido for Acoustic Neuroma Foundation (www.AcousticNeuromaFoundation.org)
First published on April 16, 2004.
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