Can you hear me now?

One of the less common conditions that is a concern for pilots and for the FAA is acoustic neuroma. Also known as a “vestibular schwannoma,” it is a noncancerous and slow-growing tumor that grows on the vestibular nerve that connects the inner ear to the brain. This nerve pathway directly influences balance and hearing.

Since acoustic neuromas are slow growing, you could have one for many years and not know it until it reaches a size that begins to produce symptoms. Hearing loss is often a first indication of something going on, but again, the loss may be so gradual that the person may not really notice anything until a friend or loved one begins to notice, asking in a not-so-normal tone: “Did you hear me?”

Tinnitus, or ringing in the ears, is another symptom, although tinnitus can be a symptom of many conditions. Dizziness usually gets everyone’s attention and, if it persists, can be a strong motivation to see a doctor. Diagnosis can sometimes take a while, but a good first step is to have your hearing tested through audiometry. The audiologist will project a range of tones into each ear separately at different levels to detect the faintest sound you can hear.

Imaging using MRI or CT can narrow down the potential culprit and detect tumors only millimeters in size. If an acoustic neuroma is diagnosed, treatment options include monitoring with periodic imaging to check on growth, or, if the tumor continues to grow or becomes symptomatic, surgery or radiation therapy.

From the FAA perspective, medical certification following a diagnosis and/or treatment for acoustic neuroma is likely if there is evidence of recovery without significant post-treatment complications. The acoustic neuroma disposition table provides guidance to aviation medical examiners about issuing a medical certificate at the time of the exam. If treatment with surgery or radiation was completed more than five years previously, and there are no symptoms, the AME may issue the exam. Otherwise, the application will be deferred to the FAA for review and will result in a special issuance authorization. As always, the FAA requires thorough records including diagnostic reports, treatment plan, surgical report, and favorable follow-up status reports. The authorization will probably be in effect for several years with annual follow-up reports to the FAA. Gary Crump is the director of medical certification for the AOPA Pilot Information Center.