Could Hearing Changes And Balance Problems Be Linked To Vestibular Schwannoma?

Changes in hearing, persistent tinnitus or problems with balance can develop for many reasons. In many cases, these symptoms are related to common conditions such as age-related hearing loss, ear infections or disorders affecting the inner ear. However, when symptoms are persistent, occur on one side, or gradually worsen over time, further investigation may be recommended.

One possible cause is vestibular schwannoma, also known as acoustic neuroma. Although relatively uncommon, this non-cancerous tumour can affect hearing and balance by growing on the vestibulocochlear nerve.

What is a Vestibular Schwannoma?

A vestibular schwannoma is a usually slow-growing, non-cancerous tumour that develops from Schwann cells, which form the protective covering around nerves.

The tumour most commonly arises on the vestibulocochlear nerve (also called the eighth cranial nerve), which carries information between the inner ear and the brain. This nerve has two important functions:

• Supporting hearing
• Helping maintain balance

As the tumour grows, it may place pressure on the nerve, leading to a range of symptoms. In some cases, it may also affect nearby structures, depending on its size and location.

The terms vestibular schwannoma and acoustic neuroma refer to the same condition, although vestibular schwannoma is now the preferred medical term because it more accurately describes where the tumour develops.

What symptoms can a Vestibular Schwannoma cause?

Symptoms often develop gradually and may initially be subtle. Because they can resemble those of more common ear conditions, diagnosis may sometimes take time.

Common symptoms include:

• Hearing loss in one ear
• Persistent tinnitus (ringing, buzzing or other sounds in one ear)
• Problems with balance or unsteadiness
• Dizziness or vertigo
• A feeling of fullness in one ear
• Difficulty understanding speech, particularly in noisy environments

Not everyone experiences the same combination of symptoms, and the severity can vary considerably from person to person.

When is hearing loss more concerning?

Hearing loss has many possible causes, but certain features may suggest that specialist assessment is appropriate.

For example, further investigation may be recommended if hearing loss:

• Primarily affects one ear
• Gradually becomes more noticeable
• Is accompanied by tinnitus
• Occurs alongside balance difficulties
• Cannot be explained by another ear condition

A hearing assessment, together with specialist neurological and radiological evaluation, can help determine the underlying cause.

Understanding tinnitus

Tinnitus describes the perception of sound without an external source. People may hear ringing, humming, buzzing, whistling or hissing.

Tinnitus itself is a symptom rather than a diagnosis and has many possible causes, including:

• Hearing loss
• Exposure to loud noise
• Certain medications
• Disorders affecting the inner ear
• Neurological conditions

When tinnitus affects only one ear or occurs alongside hearing changes and balance problems, imaging may be recommended to exclude conditions such as vestibular schwannoma.

Why balance problems occur?

The vestibular portion of the eighth cranial nerve plays an important role in helping the brain interpret signals about movement and position. When a vestibular schwannoma affects this nerve, communication between the inner ear and the brain may be disrupted.

Patients sometimes describe:

• Feeling unsteady while walking
• Reduced confidence on uneven ground
• Difficulty maintaining balance in the dark
• Mild dizziness
• Occasional vertigo

Because symptoms often develop gradually, many people unconsciously adapt over time, making changes less obvious until they become more noticeable.

How is Vestibular Schwannoma diagnosed?

Diagnosis begins with a detailed review of symptoms and medical history.

Specialist assessment may include:

• Neurological examination
• Hearing tests (audiology)
• Balance assessment where appropriate
• High-resolution Magnetic Resonance Imaging (MRI)

MRI is considered the most effective imaging technique for identifying vestibular schwannoma and determining its size and location. Advanced imaging also helps specialists assess whether nearby cranial nerves or surrounding structures are affected.

Treatment options

Management of vestibular schwannoma is tailored to the individual and may involve one or more approaches depending on the tumour's characteristics.

Possible treatment options for vestibular schwannoma include:

Active monitoring

For small tumours that are not causing significant symptoms, regular MRI scans and hearing assessments may be recommended to monitor for changes over time.

Microsurgery

Surgical removal may be considered for selected patients, particularly if the tumour is larger, growing or causing significant symptoms.

Gamma Knife radiosurgery

For carefully selected patients, Gamma Knife offers a non-invasive treatment option that delivers highly focused radiation to the tumour while minimising exposure to surrounding healthy tissue.

The aim is to control tumour growth while preserving neurological function wherever possible. Whether Gamma Knife is appropriate depends on the size, location and characteristics of the tumour, alongside the individual's overall clinical picture.

The importance of specialist assessment

Vestibular schwannoma can present with symptoms that overlap with many other conditions affecting the ear and nervous system. For this reason, assessment by a specialist team is important to ensure an accurate diagnosis and an evidence-based treatment plan.

If you have ongoing hearing changes, persistent tinnitus in one ear or unexplained balance problems, seeking specialist advice can provide clarity and help determine whether further investigation is needed.

Explore the Queen Square website to learn more about our specialist assessment and treatment for vestibular schwannoma.