ANA Discussion Forum
General Category => AN Issues => Topic started by: Esperanza on March 05, 2010, 09:54:30 am
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Every so often I take a look at new research and I've come across this - interesting hypothesis - got me wondering how many of us have suffered with a cold sore at sometime during their lifetime - is there the link they think there may be? I don't think I agree with the 'increase in symptoms only if the enlarge' idea... Personally I had cold sores now and again in my youth - haven't had one for years...
Herpes and acoustic neuromas: Is there a cause and effect to observe?
Craig G. Burkhart *
University of Toledo College of Medicine, Toledo, OH, USA
Ohio University College of Osteopathic Medicine at Athens, 5600 Monroe Street, Suite 106B, Sylvania, OH 43560, USA
a r t i c l e i n f o
Article history:
Received 8 January 2010
Accepted 17 January 2010
Available online xxxx
s u m m a r y
Acoustic neuromas are a result of damage to the affected nerve function and can potentially press surrounding
tissues. Although some sources suggest that observation is the treatment of choice for only
those over 65 years of age and those unable to tolerate undergoing surgery or radiosurgery, most affected
individuals should strongly consider not doing any aggressive therapies. Herpes has already been shown
to mimic acoustic neuroma clinically, but growing evidence suggests that it is likely the cause of most
cases of this entity.
2010 Elsevier Ltd. All rights reserved.
Acoustic neuroma, or vestibular schwannoma, is a benign tumors
located on the eighth cranial nerve. The nerve is insulated
by layers of specialized cells called Schwann cells, and it is the multiplication
and thickening of these cells which forms the tumor.
This nerve traverses from the inner ear to the brain and the growth
can be situated anywhere on this path. Acoustic neuromas do not
metastasize, but damages the affected nerve function and can
potentially press surrounding structures.
The present options for treatment of acoustic neuromas
include:
1. Surgery (partial or total tumor removal) with three basic
approaches (translabyrinthine, retrosigmoid/sub-occipital,
middle fossa).
2. Radiation therapy (including stereotactic, gamma knife, cyberknife,
linear accelerator, fractionated radiation therapy).
3. Observation.
In America, observation is the treatment of choice for only two
categories of patients: those over 65 years of age, and those medically
unable to tolerate undergoing surgery or radiosurgery [1]. Indeed,
the 1991 Consensus Conference of the National Institutes of
Health recommended surgical excision as the treatment of choice
for symptomatic acoustic neuromas. Aggressive treatment has
been promoted by authors who have drawn an overpessimistic
prognosis by suggesting that they ‘‘eventually cause clinically significant
problems, then death if not treated [2].†In truth, most tumors
cause few symptoms besides depressed unilateral hearing
loss; of note, both surgery and radiotherapy cause total loss of
hearing of the affected nerve as well as potentially significant other
risks.
Observation is the standard in many countries including Japan
and Canada [3,4]. Moreover, observation is suggested as appropriate
therapy by the Acoustic Neuroma Association, the American
Hearing Research Foundation, and meta-analysis with suggested
treatment algorithm [5].
Although some countries are more surgically oriented, observation
should be a strong consideration in all patients regardless of
age or ability to withstand surgery. The reasoning for observation
begins by realizing that acoustic neuromas are benign tumors
and only produce symptoms, besides decreased hearing, if they enlarge.
On point, most acoustic neuromas grow very slowly. In one
study, 85% of patients had no change in tumor size after over 4
years of follow up [6]. Bederson et al. [7] actually reported 6% of
acoustic neuromas decrease in size with time.
Acoustic neuromas are much more common than reported, as
0.8–2.7% of cadavers reveal asymptomatic intracanalicular acoustic
neuromas [8,9] Thus, most afflicted individuals do not have surgery
or radiation therapy, as these individuals just assume that
they have ‘a bad ear,’ and live with it.
As stated above, acoustic neuromas represent an injury-like response
of Schwann cells. Of interest, herpes may be a major cause
of this defect. To begin with, herpes can actively multiply within
Schwann cells [10]. Herpes has already been shown to mimic
acoustic neuroma on MRI [11] The virus commonly reactivates
upon injury to the acoustic nerve, such as with nerve resection
[12,13]. Just as the herpes virus has been implicated with Ramsay
Hunt syndrome and Bell’s palsy, it has been suggested to be the
cause of delayed facial palsy with surgery to acoustic neuromas
[13]. Herpes virus has been found within the parenchyma of virtually
all organs of the body as well as within the dorsal root ganglia
throughout the spinal column of all humans [14]. In a symbiotic
relationship, the body retains the virus because it offers its human
host oncolytic, immune-stimulating, and anti-tumor properties
[14]. Although the herpes virus can act as a pathogen causing serious
disease, such as acoustic neuroma, the virus also offers benefits.
Thus, the body stores the virus in several locations within
the host, whereby they can exist in a latent site or reproduce and
substances on demand by initiating factors [14].
Unless a neuroma grows producing other symptoms due to
compression, the risks of surgery seem way out of proportion to
any perceived benefits. As stated by Flint [15], ‘‘delaying surgery
until required by symptoms or tumor growth does not result in
more morbidity.†Additionally, better treatments may be on the
horizon, including chalcone derivatives and anti-herpetic
prophylaxis.
0306-9877/$ - see front matter 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.mehy.2010.01.010
* Address: Ohio University College of Osteopathic Medicine at Athens, 5600
Monroe Street, Suite 106B, Sylvania, OH 43560, USA. Tel.: +1 419 885 3403; fax: +1
419 885 3401.
E-mail address: cgbakb@aol.com.
Medical Hypotheses xxx (2010) xxx–xxx
Contents lists available at ScienceDirect
Medical Hypotheses
journal homepage: www.elsevier.com/locate/mehy
ARTICLE IN PRESS
Please cite this article in press as: Burkhart CG. Herpes and acoustic neuromas: Is there a cause and effect to observe?. Med Hypotheses (2010),
doi:10.1016/j.mehy.2010.01.010
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Esperanza,
Thank-you for sharing this article!!! I found it quite interesting, to say the least. I have had cold sores off and on for years, since childhood. I wonder if there is really a connection? I have to admit, I do agree with alot of what has been presented in this article!
Again, thank-you for bringing this article to the forum. Blessing to you............
Jackie from Oregon
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Esperanza ~
Although I've experienced relatively mild cold sores many times I'm a tad skeptical of this report's conclusion regarding a direct link between Oral Herpes (human herpes simplex virus - 'HSV-1') and acoustic neuromas. I would like to see more of the 'growing evidence' mentioned in the article.
I'm afraid that I have to disagree with many of the statements made in this article, even though it's authored by doctors and of course, I do not possess a medical degree. It states that observation, what we call 'watch-and-wait' is recommended for AN patients over 65. I was 63 at the time of my diagnosis. My neurosurgeon didn't hesitate to recommended de-bulking surgery, then radiation for my AN. In fact, my age was never even mentioned as a factor in his treatment recommendations, perhaps because I was otherwise in good health with no medical issues at that time. The article also states that observation is strongly recommended because the tumors are benign and very slow growing so surgery and/or radiation is often not really necessary. The paper also downplays the consequences of delaying surgery or radiation and infers that doctors 'promoting' surgery and/or radiation are mistaken. The authors claim : "In truth, most tumors cause few symptoms besides depressed unilateral hearing loss; of note, both surgery and radiotherapy cause total loss of hearing of the affected nerve as well as potentially significant other risks. This is a half-truth. We know for a certainty that untreated ANs very often cause all kinds of problems beyond unilateral hearing loss and that surgery and radiation do not always cause "total loss of hearing of the affected nerve" although there are 'other' risks involved, as with any procedure performed in this area.
I don't have the time to expound on these issues here but I agree that the connection between the Herpes simplex virus and acoustic neuromas is interesting and I thank you for posting this, although the patently misinformed statements elsewhere in the paper force me to question the author's credibility on this issue more than I would prefer. It'll be interesting to read other reactions to this.
Jim
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Interesting - I've never had a cold sore though so I must have got my AN because I'm lucky!
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Now, this really makes me wonder. I do agree with Jim, who said the misinformation in the article does make one question its accuracy in general. However, two docs think my AN was diagnosed "serendipitously," when I had viral labyrinthitis in January which caused them to order the MRI. After the labyrinthitis, I developed a three week bout of intestinal illness (maybe viral?). And now, I'm broke out in shingles, which is caused by a virus (varicella? herpes?). It has seemed like too much of a coincidence to me that I've had these viral illnesses and was suddenly diagnosed with the AN. Well, it doesn't really matter . . . they're going to scan me again and take another look at the little booger next week. It does make you wonder, though . . .
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ive had cold sores on and off for years, and i still get them
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I get cold sores from time to time. I used to get them very rarely, but I've had a few the past two years (they seem to be triggered by stress for me and I've been in law school for two years now, which is very stressful). However, I only get cold sores in one very specific location and it is on the side opposite of where my AN was located.
Interesting theory, though. If I remember, the basic steps of the Scientific Method are: Question, Research, Hypothesis, Test, Analyze, Result. It seems like they are still in the hypothesis stage on this one. I'm not sure how they would go about testing this hypothesis.
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I'm glad you posted this article, but in a way it's distressing to those of us that have already had surgery. It makes you wonder if you should have gone the "watch and wait" route for 6-12 months to see if there was any change before having surgery. Of course another 6-12 months might mean a bigger tumor, lower probability of retaining any useful hearing, greater probability of damage to the facial nerve etc... I guess there are no clear choices. ???
There is one clear inaccuracy in the article though. When I was diagnosed, I still had normal hearing on the bad side. I had some very minor loss of high pitch hearing, but it was within normal range and totally unnoticeable to me. I retained close to the same degree of hearing after surgery. I would say my hearing is close to 90% of what it was. The only time I notice a difference is when I am on the phone (voices are very slightly distorted) and when I wear headphones (one side is sightly louder). So saving hearing IS an option in some cases. I was one of the lucky ones.
I never suffered from cold sores, but I had frequent canker sores. I still get them from time to time. Hmmn
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I, too, found this article to be very interesting, however I am more in "Jim's Camp" than with the writer of the article. I have had VERY few cold sores in my lifetime, but have had shingles....once. I realize that some doctors just want to "cut", and others want you to "wait"...but the final analysis in all of this is what is comfortable for each individual. Regardless of what might or might not have been, most of us want to do SOMETHING pro-active and not wait for the "unknown" to take over. The AN's are REAL...are frightening (when first told), and are controllable. In my family, it could possibly be genetic...my sister has had a 2.5 cm meningioma removed 3 years ago, and my father suffered with severe headaches and hearing issues all of his life...undiagnosed problems.
Personally, I'm glad I did SOMETHING....increased symptoms and all. I have the confidence of others who are waiting to hear the great news: "It's shrinking!"
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I like that they used the words 'in most cases' b/c I also never had cold sores, etc. In fact, I was given a varicela virus titer for a new job in a hospital once & it came back negative, they then wanted me to get the varicela virus vaccine, which I didn't (& later ended up with chicken pox from an infected cousin - I was with her 1 day before she broke out !).
Always good thoughts, Nancy
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Never had a cold sore in my life - and I'm 48 1/2.
Jan
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I get cold sores but my non AN husband gets more than I do. He also had a lot of canker stores till started using a Rembrandt tooth paste with out the ingredient I think called sodium lauryl. They have changed the color of the box of it so don't know exactly which one of Rembrant it is now. It worked for him anyway. He has had shingles once too.
Cheryl R
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I have had a few canker sores in my life but never a cold sore. And I'm 58 yo.
:)
Neal
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Canker sores all the time, especially when I eat the fresh ripe seasonal fruit or I'm very stressed about something. Cold sores never and I'm 50 yrs old.
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Thank you for posting this article, I read it with great interest. I believe is you are pron to cold sores, which I am, that it could possibly be activated during surgery. You can bet that I will ask my Dr. if I can be put on medication for a few days to avoid an episode of facial paralysis after surgery. I do so much appreciate the information I get on this site. Thanks Again ;D
Sue in Michigan
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I had some real bad cold sores the month before the surgery that required oral prescription medication. i don't think this is a correlation but a coincidence because I was under stress about the oncoming surgery and all I had to prepare for. I am prone to cold sores and hadn't had one in years. Stress brings them on and pending AN surgery sure is a stress factor.
Mei Mei
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I have had hideous cold sores since I was in my early teens. I get probably two a year and they last two weeks. Another interesting little tidbit in trying to make sense of anything!
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This is very interesting. I have been on an anti-viral for my cold sores for over 20 years, since I was in a clinical trial at NIH to test the drug. As I understand it (and I'm not a medical professional!!!) some of the herpes viruses lay dormant in the nerves for years. So, while you may be asymptomatic, you still have the virus in your system.
Thanks for bringing this research to the forum!
staypoz
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This is a interesting connection! I`m saying that if this is a possibility, more inclined to keep a very healthy lifestyle. From my research viruses, cold sores, canker, herpes, are more likelkey to flair up when resistance is low along with stress related factors. As for myself I`ve had an occasional cold sore and tiny wart here and there. Nothing to talk about. Mickey