An acoustic neuroma (also called a vestibular schwannoma) is a benign, usually slow-growing tumour on the nerve that carries balance and hearing information from the inner ear to the brain. It most often causes hearing loss and ringing in one ear, along with unsteadiness and sometimes dizziness. It’s diagnosed with an MRI and managed by ENT and neurosurgery specialists, who may recommend monitoring, radiosurgery or surgery. Vestibular rehabilitation doesn’t treat the tumour itself, but it can help your brain adapt to the loss of balance function — before treatment, and especially after it. At McKelvie Physiotherapy in Pickering, we build that rehab program around your medical plan.
At a glance
- What it is
- A non-cancerous, usually slow-growing tumour on the balance nerve that connects the inner ear to the brain
- Common symptoms
- Hearing loss and ringing in one ear, unsteadiness and, less often, vertigo
- Diagnosis
- An MRI, usually arranged after a hearing test shows hearing loss in one ear
- Medical management
- Monitoring with repeat MRI, stereotactic radiosurgery or surgery — decided with your ENT and neurosurgery team
- Role of vestibular rehab
- Gaze, balance and walking exercises that help the brain adapt to balance loss, before and after treatment
- At McKelvie
- 60-minute vestibular assessment with infrared video goggles ($180) in Pickering; no referral needed
What is an acoustic neuroma?
An acoustic neuroma — more accurately called a vestibular schwannoma — is a non-cancerous (benign) tumour that grows on the vestibular nerve, the nerve that carries balance information from the inner ear to the brain. It sits right next to the hearing nerve, which is why hearing is so often affected too.
Most acoustic neuromas grow slowly, over years rather than months, and they usually affect one side only. Because they grow so gradually, the brain often adapts to the slow loss of balance function on that side — so many people notice hearing changes and mild unsteadiness long before they ever feel true vertigo.
What causes an acoustic neuroma?
Acoustic neuromas develop from an overgrowth of Schwann cells, the cells that form the protective covering around the nerve. In most people there’s no known cause.
Less commonly, tumours grow on both sides. This is usually linked to a rare genetic condition called NF2-related schwannomatosis (formerly neurofibromatosis type 2), which is managed by specialist medical teams.
What are the symptoms of an acoustic neuroma?
- Gradual hearing loss in one ear — often the first sign
- Ringing or buzzing (tinnitus) in one ear
- Unsteadiness or imbalance, especially in the dark or on uneven ground
- Dizziness and, less often, episodes of vertigo
- A feeling of fullness in the affected ear
- With larger tumours: facial numbness or tingling, headaches or, rarely, facial weakness
After surgery or radiosurgery, many people notice a period of dizziness and imbalance as the brain adjusts to reduced balance function on the treated side — this is where vestibular rehab is most useful.
When to see a doctor urgently
Sudden hearing loss in one ear should be assessed by a doctor as soon as possible — ideally the same day — because early treatment matters. Hearing loss or ringing in one ear that develops gradually should still be checked by your family doctor, who can arrange a hearing test and refer you to an ENT specialist.
If you’ve had surgery and develop a severe headache, fever, a stiff neck or clear fluid draining from your nose or wound, contact your surgical team or go to the emergency department right away.
If dizziness comes on suddenly with a severe headache, trouble speaking, facial drooping, weakness, numbness or loss of vision, call 911 — these can be signs of a stroke.
How is an acoustic neuroma treated?
Diagnosis and management of the tumour are handled by your medical team:
- Diagnosis — an MRI confirms an acoustic neuroma, usually arranged after a hearing test shows hearing loss in one ear.
- Watch-and-wait — many small, slow-growing tumours are simply monitored with repeat MRI scans.
- Stereotactic radiosurgery — focused radiation to stop or slow the tumour’s growth.
- Surgery — removal of the tumour by an ENT (neurotology) and neurosurgery team.
Which option is right depends on the tumour’s size and growth, your hearing, your age and your overall health — decisions you’ll make with your specialists.
Vestibular rehabilitation is where we come in. It doesn’t treat the tumour, but it does help with the imbalance and dizziness that can come with it — and particularly with the sudden loss of balance function on one side after surgery. Clinical practice guidelines recommend vestibular rehabilitation for people with reduced inner-ear balance function, including after surgery (Hall et al., 2022), and a 2024 systematic review found that multimodal programs — gaze stability, habituation, balance and walking exercises — showed potential to improve dizziness and balance in people with vestibular schwannoma, though more high-quality research is needed (Yap et al., 2024).
Some people also choose vestibular “prehab”: starting balance and gaze exercises before surgery, so they know the exercises, have a baseline measurement and can get moving sooner afterwards.
Assess
A detailed vestibular assessment with infrared video goggles to measure your balance, gaze stability and walking, and to understand where you are in your medical plan.
Prepare or adapt
Before treatment, a prehab program to build a baseline; after treatment, gaze stability and balance exercises matched to how your brain is compensating.
Rebuild
Progressive walking, balance and real-world practice to restore confidence, with updates shared with your medical team where helpful.
Why choose McKelvie Physiotherapy for acoustic neuroma rehab?
- Led by an Advanced Vestibular Physical Therapist (AVPT) — vestibular rehab is our clinical focus, not a sideline.
- Advanced diagnostic technology — we use infrared video goggles (video-oculography) to record eye movements the naked eye can’t see, so your diagnosis is based on evidence, not guesswork.
- One-on-one care in private rooms — every session is with your physiotherapist, start to finish.
- Part of your wider team — we work closely with local ENT specialists and keep your care aligned with your medical plan.
- Care that comes to you — in person in Pickering, at home across the GTA when travel is hard after surgery, or virtually anywhere in Ontario.
- Direct billing to many major insurers — and no referral needed.
Sources
- Vestibular Schwannomas. New England Journal of Medicine (Carlson ML, Link MJ), 2021.
- Vestibular Rehabilitation: Improving Symptomatic and Functional Outcomes of Persons With Vestibular Schwannoma: A Systematic Review. Physical Therapy (Yap J, et al.), 2024.
- Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. Journal of Neurologic Physical Therapy (Hall CD, et al.), 2022.