March 2, 2011, was the thirteenth anniversary of my AN operation at the House Clinic in LA. This is my story.
About 17 years ago, at age 43, I started to experience difficulty with my hearing. At work, I had the phone on my desk on the left-hand side, but found myself switching the phone to my right ear to better understand phone conversations. After about a year of this, I scheduled a hearing test with an Audiologist. I was not surprised when the test showed a 4% loss in my left ear, cause by nerve damage. It also did not surprise me because my 92year old father is deaf in one ear and cannot hear out of the other. His hearing has been bad since his early 30s and has gotten to where it is very difficult to converse with him especially in crowds.
My Audiologist, Dr Palm, is also my fathers' doctor. Eliminating any occupational or recreational cause for my unilateral loss, Dr Palm referred me to an ENT, Dr Overholdt, (also my fathers' doctor) to see if there was anything medically wrong with my ear. He could see nothing that would attribute to my nerve loss, and suggested doing an ABR and an ENT test, to rule out the number one cause of unilateral hearing loss …Tumors! The tests were conducted a few days later and, though the test did not find the cause for my hearing loss, It did not show any sign of tumors.
I had follow up hearing tests done every year, in November, at the same time I had my annual physical The first year there was no change in hearing, as was the second year. The third test I had showed another 2% drop in hearing and a 1% drop in the hearing of my good, right ear. No need for concern…I was going to slowly loose my hearing like my father, I thought.
The fourth year, I noticed significant hearing loss in that same left ear. It became so noticeable that I asked my wife to change sides of the bed so I could hear her as I lie in bed with my bad ear on the pillow.
As we were getting ready to move to San Diego, on January 1st. 1998, I put off my annual physical and hearing test until mid December.
I was sure the hearing test would show additional hearing loss, and sure enough, Dr Palm said I now had a 12% hearing loss, and it was time to get a hearing aid. I was not surprised and had settled on getting the hearing aid as advised. Just in case, Dr Palm sent me to see my ENT, Dr Overholdt, again to see if he could determine a medical cause for the loss. Dr Overholt scheduled me for a MRI. The MRI was scheduled for the day after Christmas, December 26th 1997, at 8:00 in the morning, with a Doctors appointment at 3:00 that Friday afternoon. I was thinking about not going through with it, as our daughters would both be home for Christmas and they were going to help us pack for the move.
I had the MRI, and that afternoon my wife, Jo, accompanied me to my appointment with Dr Overholt. I really didn't know why she wanted to come just to hear the doctor say that the MRI didn't show anything, and that there again was no medical reason for my "inherited hearing loss". We entered the exam room and the nurse put up the MRI film on the wall viewer and I asked her how the looked. She replied " Well there is nothing circled in red, so that’s good….but then what do I know", and she left. Jo and I looked at the film, and also could not see anything that looked out of the ordinary….but then what do we know! After about 10 minutes, Dr Overholt walked in, greeted us, walked over to the viewer and said, "looks like we've got a tumor"!
He said it was an, Acoustic Neroma, an extremely rare (4 in 100,000), benign tumor on the 8th nerve, the Vestibular or balance nerve in the brain. The size was about 1cm, categorized as small. The 8th nerve is in a bundle of nerves that run together in the bonny ear canal along with the nerves for hearing and facial movement. The tumor was destroying my balance, but because of its' slow growth, the balance nerve on the right side was compensating. The hearing loss was because the tumor was now growing on to my hearing nerve. If left alone it would destroy my hearing, affect my facial nerve, my eye, and eventually work to the brain stem and cause death.
Dr Overholt knew of my move to San Diego and said" The best doctor in the world is in Los Angeles, and he would be the one I would have perform the surgery if it were me." The question was could I get my Insurance Company to allow it to be done there! My insurance was a Preferred Provider Organization, and I was not sure they would allow that.
Remember, I am moving in five days! The furniture is packed, the moving company is coming Monday and, we are flying out next Wednesday, New Years Eve!! Dr Overholdt, scheduled a surgical evaluation with a Neurosurgeon, Dr Lihu, for the following Tuesday the 30th. I could move and then come back in three weeks for surgery, I have plenty of family here and my Insurance Company might require it.
When we returned home, we informed our daughters of the results, and our oldest daughter, Kim, went to the computer, got on the Internet and started printing information faster than my wife and I could read it. In very short order, we learned everything there was to know about Acoustic Neroma.
We met with Dr Lihu, on Tuesday. He informed us that I had a 50-50 chance of losing all hearing in the affected ear. I would have temporary balance problems. I should expect at least temporary facial nerve damage, possible spinal fluid leakage, and even possible chronic headaches after surgery. His prognosis was similar to what Dr Overholt had told me earlier. Though he was helpful and informative he had only performed four such operations during his practice.…. I really did not want to be number five.
The move to San Diego went as planned. I called Los Angeles and made an appointment at the House Clinic, with Doctor Derald Brackmann, "the best doctor in the country", for January 14th. The day before the appointment we drove to Los Angeles, and spent the evening with my brother d***, and his wife, Mary, who had offered to accompany us to the appointment.
The meeting with Doctor Brackmann went very well. He was very friendly, knowledgeable, and experienced. He had done several studies on the condition, published numerous articles, and had participated in over 3500 Acoustic Neroma Surgeries. His team had pioneered a revolutionary technique, the Middle Fossa Approach, which approaches the tumor from above and in the front of the ear. This approach allows for complete removal of the tumor, located at the base of the brain. It reduces the time the brain has to be retracted, and eliminates postoperative headaches, caused by entry in the back of the skull with the sub-occipital approach…the common approach by most neurosurgeons.
Doctor Brackmann sat for an hour taking questions from the four of us. We had all read up on the subject and he was surprised at our knowledge, as we were of his detailed responses. Upon leaving the clinic, the decision was made….He was the Man, the One to do the surgery. The question was: Would our Insurance Company allow the surgery be performed by him, and how much would they pay?
I had received verbal assurance from our Agent, that the Company would allow it, at "out of network" reimbursement of 70%. Prices are quite a bit higher in California, and Dr Brackmann's fees reflected his expertise. I sent estimates for the surgery to the Company for review and approval to schedule it ASAP.
Dr Brackmanns' secretary informed us that he was leaving the country the last three weeks in March so we where under the gun to make a decision. After five weeks of dealing with the Insurance Company and not getting an answer either way, I ran out of time. On February 18th, I scheduled the surgery for Monday March 2nd at noon.
Our youngest daughter, Kari had plans to come to visit us on March 7th. She was able, after a lot of fast talk and hard work, to change her flight to arrive Sunday a week earlier than planned, the day before surgery. Her plans were to stay in California for two weeks.
Kim, our other daughter had just relocated to Tampa, FL on February 16th, and likewise checked the internet and the discounted ticket brokers and found a Tampa to San Diego fare for $170.00. They both flew into San Diego with in minutes of each other, Sunday at 11:00. We took them on a quick tour of San Diego, and then head to Los Angeles. I had to be at the hospital at 7:30 Monday morning, so we all stayed at my brothers' house Sunday evening.
Surgery went as scheduled in Los Angeles on March 2nd, and all things considered, I survived very well! The tumor turned out to be somewhat larger than anticipated, 1.2cm, but the location was ideal. The tumor was growing on my vestibular nerve and pushed against my acoustic nerve, but was not growing on it. Dr Brackmann and Dr Hitselberger were able to limit the damage only to the cutting of the balance nerve, no other damage to the facial, eye, and hearing nerves. No headaches, no side effects!!
I was released from the hospital on Sunday the sixth day following surgery. Jo, Kim, & Kari stayed in LA at my brother d***'s house, and I recuperated there for five days after I was released. They shaved half of my head, and when I got out of the hospital, I had the rest shaved….I looked like "Bull" from Night Court. I went back to the clinic on Wednesday the 11th, nine days after surgery and was released for good. I do not have to see the doctors again unless I have problems. They suggested a MRI be done in five years, just to make sure there is no regrowth.
I was given, among other preoperative tests, an ABR and an ENG test…….both of which turned out NORMAL, meaning the tumor was not detected!! My hearing test showed the same loss as was found by Dr Palm. I was also given a hearing test following surgery on Wednesday March 11th. To my surprise and theirs, my tone hearing was the same as the test I was given just before surgery, but my understanding of speech had improved. It is very possible that my understanding will improve more as the healing progresses. My improvement as far as balance and fatigue was good, but tapered off to slow. I did not drive a car for a month and rode my bike for the first time two weeks after that.
Five years after surgery, I had a normal MRI. I followed up at ten years post op, and was told then that I needed no more MRIs, unless symptoms re occurred. I have one small side effect; my balance is not as good as I think it should be. However I ride a bike and downhill ski with no problem. It may just be getting old. Overall….I am a very blessed man.
