Because acoustic neuromas are benign, usually slowly growing, lesions treatment decisions for patients of any age depend on factors such as age at diagnosis, health of the patient, the size of the tumor, and hearing in the affected ear. Treatment of elderly patients with acoustic tumors is controversial and demands consideration of tumor size, age of the patient, and health status. Small tumors in patients of advanced age or who are in poor health may be serially scanned and treated if their tumor grows. Complete surgical excision, as for younger patients, is recommended by some surgeons, but others believe that a palliative subtotal resection is wiser. For elderly patients with vertigo, surgical removal may be recommended, even if the acoustic neuroma is small.
Radiation is an alternative for selected patients.
Tumors of the middle ear and mastoid are rare. The first symptom of a glomus tumor of the ear is pulsatile tinnitus followed by conductive hearing loss. A small percentage of paragangliomas produce hormones which, in rare cases, cause intermittent hypertension. A pulsatile red mass in the middle ear is the hallmark of glomus tumors. Tuning fork testing and an assessment of the cranial nerves may reveal abnormalities.