Dear Dr. Roach: As a result of neurofibromatosis type 2, I have bilateral acoustic neuromas, which I have lived with for many years. These noncancerous tumors, also known as schwannomas, on my auditory nerves have caused my hearing to worsen over time. What is your opinion about the current treatment options?


Dear T.D.: Acoustic neuromas are exactly as you describe, noncancerous tumors arising from the Schwann cells that surround and protect the eighth cranial nerve, which is responsible for hearing and sense of balance. These tumors can happen sporadically or in people with neurofibromatosis type 2. The most common symptoms are gradual hearing loss and tinnitus.

Treatment can be with surgery or radiation. For surgery, find an experienced surgical team, usually a neurosurgeon and a specialist in ear surgery. Surgical cure can be limited by a desire to preserve the affected eighth nerve and its nearby companion, the eighth cranial nerve (facial nerve), responsible for muscle control of the face. Hearing rarely improves after surgery, so early identification of the cause of hearing loss and tinnitus is critical.

Radiation, including stereotactic techniques such as gamma knife, and newer modalities such as proton beam, is an effective treatment also, but it may have lower rates of hearing preservation. The best treatment depends on so many factors that only a specialist can make the correct recommendation.

NF2 is a rare disorder (about 1 in 25,000 people) that can occur in families or as the result of a gene mutation. Ninety to 95 percent of people with NF2 will develop acoustic neuromas, usually by age 30. Management of acoustic neuromas in NF2 is more complex than in people with sporadic tumors, and usually includes surgery rather than radiation. Recurrence and complication rates may be higher in NF2 patients than in those with sporadic tumors. Not all tumors need to be treated, especially since treatment sometimes fails.

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Dear Dr. Roach: My husband was diagnosed with trapezius muscle strain, but he remains in constant pain throughout his shoulder and back. Can you tell us about this condition?


Dear P.K.: The trapezius is a large muscle that inserts on the spine all the way from the top of the neck to the lumbar spine on one side, and the shoulder blade on the other. It’s called trapezius because it is in the shape of a trapezoid (as is a trapeze).

Because it is such a large muscle, it can have pain in many areas. However, a trapezius injury can lead to a rotator cuff injury, and I’d get him re-evaluated if the pain lasts more than a week or two.

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