Sudden hearing loss is usually linked to cochlear inflammation but may, in rare cases, indicate the presence of an acoustic neuroma, or vestibular schwannoma. And when it comes to acoustic neuroma surgery, two sets of eyes on an ear can make all the difference.
That’s why Mia Miller, MD, and John Yu, MD, have teamed up to deliver exceptional patient care at Cedars-Sinai’s Acoustic Neuroma and Lateral Skull Base Tumor Program. The pair combine their expertise to treat neuroma tumors, which—while noncancerous—can leave patients with seriously disruptive symptoms, such as vertigo, tinnitus or hearing loss. If left untreated, the tumors can press against the brain stem and impact neurological function or become life-threatening.
The Cedars-Sinai Difference
An estimated 2 to 4 in 100,000 people are affected by acoustic neuromas, and 80%-90% of cerebellopontine angle lesions are acoustic neuromas. Cedars-Sinai was named #1 in Los Angeles and #7 in the nation for Neurology & Neurosurgery, according to U.S. News & World Report’s“Best Hospitals 2022-2023” rankings, and that expertise is of utmost importance when it comes to surgical treatment of this condition. So is the access Cedars-Sinai provides to innovative neurology research and groundbreaking clinical trials.
As co-directors of the Acoustic Neuroma and Lateral Skull Base Tumor Program at Cedars-Sinai, Miller and Yu highly value their partnership in the operating room. As an otologist/neurotologist, Miller possesses a deep understanding of bone anatomy and the locations of nerves in and around the ear. As an experienced neurosurgeon, Yu is highly specialized in brain anatomy and monitoring neurological function.
“We bring different strengths to patient care,” Yu said. “We complement each other very well. Our different disciplines and the parts of the tumors that we specialize and develop expertise in allow us to deliver outstanding care for the people we serve.”
Treatment Goal: Preserving Hearing and Facial Nerve Function
Miller and Yu specialize in two methods of surgery to address acoustic neuromas. The first is radiosurgery, which stops tumor growth through directing focused beams of radiation at the tumor. The other option is microsurgery, which offers a chance to preserve the patient’s current level of hearing.
The surgery can be completed through three approaches: translabyrinthine, middle fossa and retrosigmoid. The translabyrinthine approach sacrifices hearing but is effective for large tumors, while the other two approaches preserve hearing. The full range of procedures is available at Cedars-Sinai, depending on the tumor’s location and which treatment best suits the tumor.
The surgery itself is an incredibly delicate affair, requiring precise movements so as not to affect surrounding nerves that impact hearing, balance and facial muscles.
“These surgeries are very particular because the tumors grow from the covering of the hearing and balance nerves,” Miller said. “As we remove the tumors, we aim to preserve hearing and avoid the risks of working close to these critical nerves.”
Innovative Treatments and Research
Miller and Yu enjoy the collaborative nature of the team at Cedars-Sinai, and they often work directly with other specialists—including facial nerve and vestibular specialists, audiologists, radiation oncologists, physical therapists, neurophysiologists, and more—to provide a multidisciplinary approach and ensure comprehensive care. A dedicated patient care navigator also supports each patient through every step of the process.
Patients at the Cedars-Sinai Acoustic Neuroma and Lateral Skull Base Tumor Program also benefit from access to innovative therapies and research.
In the lab, Yu collects and isolates schwannoma stem cells from the acoustic neuromas he and Miller treat, propagating the cells to identify which tumor stem cells generate benign tumors. This research aims to support additional testing and animal models to develop new therapies and medications.
The pair is also working on immunotherapy that would target acoustic neuromas in patients with neurofibromatosis 2, a genetic disorder that puts patients at risk for the tumors.
Another forthcoming clinical trial uses scorpion venom dye to fluoresce the schwannoma immediately prior to surgery, enabling surgeons to visually distinguish the nerves from the tumor and decreasing the risk of complications.
“We’re pushing new therapies and making the surgeries safer,” Yu said. “We’d love for our research to really impact care. We’re working toward developing trials that will provide information for the novel therapies of the future.”
If you’d like to refer a patient to Cedars-Sinai’s Acoustic Neuroma and Lateral Skull Base Tumor Program, please call 310-423-7900.
On August 22, we are hosting an informational discussion (virtual and in-person) for people with acoustic neuromas and those who care for them. If you have a patient who wishes to attend, they can RSVP to acousticneuroma@cshs.org.
