Not all patients with acoustic neuroma have to lose their hearing
B. Gregory Thompson Jr., M.D. and Steven A. Telian, M.D. offer the middle fossa microsurgical technique, an innovative approach to removing an acoustic neuroma that has an 80 percent success rate for preserving hearing.
Lorraine Poppleton saw 24 doctors in the course
of a year, but they were dismissive of her bouts
of dizziness, tinnitus and the intrusion of an
occasional whistling and tapping sound like
She credits New York neurologist Joseph C. Casarona, M.D., for being the first doctor to take her condition seriously. He prescribed Antivert (meclizine) for her vertigo, but it only gave her relief for two days. Casarona then ordered an MRI which revealed Poppleton had a tumor growing on her auditory nerve -- an acoustic neuroma.
Poppleton's case is a classic example of a patient whose quality of life would have been unnecessarily damaged by the predominant surgical approach to removing these tumors, says Steven A. Telian, M.D., the John L. Kemink Professor of Neurotology in the Department of Otolaryngology at the University of Michigan Medical School.
"Doctors can let their patients know that there are options out there that can preserve hearing in a large percentage of acoustic neuroma cases," Telian says.
Poppleton's tumor remained stable for about a year and a half, but a follow-up scan in 2009 showed it was growing.
"They told me, "It's on the move," Poppleton recalls.
She sought out three opinions from doctors at major New York medical centers. They all recommended removing the tumor using a translabyrinthine approach, which enters the auditory nerve canal through the mastoid bone behind the ear. The technique always results in a complete loss of hearing.
"They all told me the same thing," she says. "I'd lose my hearing. I could expect facial paralysis. My life would never be the same. I was told by one very prominent doctor that if his colleague who had undergone this surgery could live with the side effects, so could I."
Poppleton thought she had no choice. The young, active grandmother either had to undergo surgery that she was told might put her into a wheelchair for the rest of her life or risk the tumor spreading to her brain.
Two weeks before her scheduled surgery, however, her son-in-law, a house officer in U-M's Department of Dermatology, informed her of an interdisciplinary program at U-M skilled in newer techniques. The team offers an innovative approach that studies have shown has an 80 percent success rate for preserving hearing.
The middle fossa microsurgical technique, as it is called, approaches the tumor from above the ear. "It gives us our best opportunity for hearing preservation, but a lot of major centers don’t even consider it strongly," says B. Gregory Thompson Jr., M.D., professor of neurosurgery at the U-M Medical School. "It requires a high degree of technical expertise."
Doctors at U-M have refined this technique over time, innovating the use of a wider opening that gives the surgeon more room and a better angle from which to attack the tumor, and employing sharper dissection tools, Thompson explains.
"It's a little counterintuitive, but we've learned from our work on brain aneurysms that using sharper tools under high magnification, there's less likely to be a rupture because there's less of the tugging you get with blunt dissection," he says. "The same principle applies to preserving the auditory and facial nerves."
Not long after forwarding her records for review, Poppleton flew to Michigan, where she had a series of preoperative tests on a Thursday and Friday. On Monday she had surgery.
She was released less than a week after the successful operation by Telian and Thompson. She was able to hear normally and soon was back at work full time, and back to jogging, playing tennis, dancing and trying to keep up with her five grandchildren.
"The take-away message is that before a patient undergoes any procedure that will sacrifice hearing, their doctors need to assess if they are a candidate for one of the approaches that can preserve hearing -- either middle fossa or posterior fossa," says Telian.
Not all centers that perform hearing preservation techniques are equally successful, Thompson cautions. Patients should inquire about prospective centers' experience and hearing preservation rates.
Each year 2,000 to 3,000 people in the U.S. are diagnosed with an acoustic neuroma. Three out of every five patients are female.
U-M Cranial Base Program
In U-M's Cranial Base program, specialists in Otolaryngology, Neurosurgery, Ophthalmology, Radiation Oncology and Medical Oncology work together to ensure comprehensive, appropriate treatment and the highest quality outcomes possible.
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Cranial/Skull Base Tumors: www.med.umich.edu/cranialbase/
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