Does anyone dive with an acoustic neuroma?

[doctormike]

You can look into middle cranial fossa approach if you will decide to get it treated - the highest chance of not disturbing middle or inner ear. From your symptoms - it sounds like you have vestibular schwannoma and not necessarily acoustic tumor (both are located in the internal auditory canal). I am sure you have a good neurootologist following you - his opinion would be valuable. Chances of dead ear from diving are really low (possible) so that would not discourage me from continuing to dive. Your vertigo with position changes is probably the most bothersome symptom as far as diving. There are several systems that body uses to compensate (help weak inner ear on the surface so your vertigo stops shortly after onset or preventing it from happening) . You are going to take most of them away under the water and that could really take you for a spin...

Again, I don't treat these myself. However, "acoustic neuroma" is a common term for vestibular schwannoma, although some have pointed out that it is inaccurate. There are a lot of examples of poor names in medicine that have become part of the language (e.g. cholesteatoma isn't a tumor).

Vestibular schwannoma is the technically correct term, because most of these tumors arise from the vestibular divisions of the 8th cranial nerve, not the acoustic portion. Also, these are tumors of the schwann cells that surround the neurons, and not of the neuron itself. Nevertheless, AN is very commonly used interchangeably with VS in the literature and in practice, because of its longstanding usage.

There are three approaches to surgical resection of these lesions - middle fossa, retrosigmoid and translabyrinthine. They all have advantages and disadvantages, and the choice depends on the specifics of the case. The decision about the approach would be made after consultation with an otology / neurosurgery team who has had a chance to review the scans and examine the patient.

Since all we know about the OP's lesion is that it is small and is being watched, I think that it's a bad idea to suggest a specific surgical approach in this forum.

 

[Ukmc]

@Ukmc What are your med credentials?

Head and Neck Surgeon. Trained as an Otolaryngologist. Have performed all three approaches to removal of vestibular schwannomas. As I mentioned in my prior post , best opinion is OP’s neurotologist’s. In response to Dr Mike comment on not suggesting surgical approach on the board, I think it is fair to do so since OP asked. Some otologist’s only prefer one or the other approach based on their training and if one doesn’t know of all their options, the best option may or may not be offered to him and then he will know to seek out a second opinion. I think since OP diverged his medical information and asked for a advice it is ok to offer it to him so he can ask educated questions of his physician.

 

[doctormike]

Hooray, another ENT doc!

You probably know more about these than I do, but I wouldn't be happy if a patient told me that I should do one approach because he was told in a scuba forum that it was best for diving. Especially since the OP isn't a diver at present.

I agree that a second opinion is always a good idea. But I am always very careful about making specific recommendations online.

 

[fintastico]

The Venn diagram overlap of people who remove acoustic neuromas and people who have dive medicine training is pretty small - there may be someone out there more appropriate to answer this than me. But what I would consider the biggest issue would be any associated vertigo, which might be exacerbated by the alternobaric phenomenon, or by the caloric response.

Most of the ear issues in diving have to do with the middle ear and inadequate equalization. There are some inner ear problems that can be caused by diving, but other than inner ear DCS, they are also associated with equalization issues (perilymph fistula, dehiscent semicircular canals, inner ear barotrauma), in which it is the interface between the middle and inner ear that causes the problem.

In the case of an acoustic neuroma, I don't see how barotrauma would affect the area of the tumor. In some cases of AN, there can be excessive pressure in the inner ear fluid (endolymphatic hydrops as in Meniere's disease), but I'm not sure if there is any study that would look at the effect of that AN association while diving. So while I'm DEFINITELY not an expert in this field, I'm not sure what the issue would be if there was no associated vertigo.

Now, this is just about the AN itself. Diving after SURGERY would depend on the approach and any complications, so that's a completely different question. Different tumors are removed with different techniques, so for that, you would have to ask your surgeon. CSF leaks, problems equalizing, etc... If it's a small AN that is just being watched, or treated with radiation, then that's not an issue. Here is something that you might find interesting on that front, from Vanderbilt - one of the best otology centers in the country. It's about how an AN patient returned to diving after a translabyrinthine approach.

Finally, one thing to consider. There is a non-zero incidence of permanent hearing loss related to a variety of diving accidents. So if you have no serviceable hearing in one ear (either before or after treatment), you have twice the risk of complete deafness when compared to someone with two hearing ears.

Hello! And THANK YOU for your detailed reply! It's interesting that you mention Vanderbilt. That is where I would have my treatment, when the time comes. I looked around a lot and chose them. I look forward to reading the link you provided.

Wishing you a wonderful day/night.

 

[fintastico]

You can look into middle cranial fossa approach if you will decide to get it treated - the highest chance of not disturbing middle or inner ear. From your symptoms - it sounds like you have vestibular schwannoma and not necessarily acoustic tumor (both are located in the internal auditory canal). I am sure you have a good neurootologist following you - his opinion would be valuable. Chances of dead ear from diving are really low (possible) so that would not discourage me from continuing to dive. Your vertigo with position changes is probably the most bothersome symptom as far as diving. There are several systems that body uses to compensate (help weak inner ear on the surface so your vertigo stops shortly after onset or preventing it from happening) . You are going to take most of them away under the water and that could really take you for a spin...

Thank you...yes, that would be a scary situation to be in, if I could not get oriented to where I was in the water. I just hate having this stupid thing...here's hoping...also, yes, the ENT doc who I met with originally spoke a bit about the middle fossa approach. Time will tell.

 

[fintastico]

Head and Neck Surgeon. Trained as an Otolaryngologist. Have performed all three approaches to removal of vestibular schwannomas. As I mentioned in my prior post , best opinion is OP’s neurotologist’s. In response to Dr Mike comment on not suggesting surgical approach on the board, I think it is fair to do so since OP asked. Some otologist’s only prefer one or the other approach based on their training and if one doesn’t know of all their options, the best option may or may not be offered to him and then he will know to seek out a second opinion. I think since OP diverged his medical information and asked for a advice it is ok to offer it to him so he can ask educated questions of his physician.

You are correct--I do not mind the info, and did indeed ask for feedback. I would not ultimately make a decision about treatment based off of any one recommendation--even from my doctor. I am also a big fan of the Acoustic Neuroma Association. They are wonderful. But the peeps there don't necessarily share my dream of being a scuba diver, so I really appreciate ALL of you divers taking time out of your day to reply to me! I appreciate it very much!

 

[Hippocampus01]

I realise that this is a very late reply, but it may help someone. My husband had one removed which had been missed for so many years that it had grown to 6cm. Strangely, although he felt dizzy very often on land, he was always fine whilst diving! He eventually was diagnosed and had it removed, or nearly all of it, and lost the whole of his ear past the flap. He had a further 5 ops to repair csf leaks within the next two years, had a dreadful time, including two bouts of meningitis and a fit. But he has now been back diving for 18 months with absolutely no issues whatsoever. The only thing that has changed, bizarrely, is that his remaining ear does not seem to require equalising!

 

[fintastico]

Hi Hippocampus01!

Wow, your husband has been through a LOT! I'm happy for him that he has gotten back to diving with no issues. ) That is fintastic. I'm sorry for what he had to go through along the way. Your post gives me hope.

Could I ask how old your husband was at diagnosis and at surgery? I'm 56 now and was diagnosed a year ago at 55.

 

[Hippocampus01]

He was 70 when diagnosed, but we think he had been growing the thing for about 15 years. That’s when he first went to the doctors because he was feeling slightly dizzy sometimes. For years it was put down to his low blood pressure. He was diving throughout this time. He had the op when he was 71. Don’t let his story frighten you, I just wanted to illustrate that provided there are no issues, it is possible to dive both before and after treatment, however tough a time you have!

 

[vickivicki]

thankyou , my hubby had one removed an inch wide Doc says it,s fine to dive bur he knows nothing about diving any updates greatly appreiated