Introduction
This leaflet will offer advice and information to you regarding the post-operative management following Vestibular Schwannoma/Acoustic Neuroma surgery.
For further information regarding the Vestibular Schwannoma/Acoustic Neuroma surgery, please refer to the ‘Surgery for Acoustic Neuroma’ leaflet provided to you pre-operatively.
Eye care
Unable to fully close your eye
Eye drops may be prescribed by the doctors if you are unable to close your eye fully. This is to prevent damage to the eye.
In order to keep your eye clean, moist and healthy it is important to manually blink your eye. This can be done by using one hand to raise your eyebrow, with the other hand use your fingertip to slide the eyelid down/closed. This should be done at regular intervals throughout the day, especially when your eyes feels dry.
You may be taught how to apply tape to keep your eye closed at night to prevent dryness. The Skull Base Specialist Nurse will discuss this further with you if taping is required.
Please also refer to the ‘Specialist Eye Care leaflet’ for more information. You might need to see a specialist eye doctor if you continue to be unable to fully close your eye. If your eye becomes red or sore at any point then please inform the ward staff or contact the Skull Base Specialist Nurse if you have been discharged.
Double vision
If you have any symptoms of double vision please inform the ward staff so that you can be provided with an eye patch to assist with these symptoms. You can wear the patch on either eye but please check your skin regularly to ensure the patch is not marking.
Ideally alternate the eye covered by the patch daily and have some periods without the patch to challenge/assist with strengthening the muscles. Always remove the eye patch when sleeping.
General eye advice
Be aware not to spend too long looking at television, computer or phone screens as these could cause dryness to the eye.
Wearing sunglasses is often beneficial to protect the eyes from excessive light as they may be sensitive initially. When walking outside in cold windy weather you could wear wrap-around style glasses (or sunglasses) to help protect the eye and prevent it becoming sore.
Mouth care
If facial weakness and altered facial sensation is present:
- Following meals sweep the tongue or finger around your teeth, especially to the back, to ensure no pockets of food remain (risk of dental abscesses)
- Brushing teeth after each meal can also be useful in preventing dental abscesses
- Check mouth daily for ulcers, cuts and sores
Facial care
If you have some facial weakness then the use of a straw for drinking can be beneficial. Using your hand to lift your cheek into a neutral position when eating and drinking can help make these activities easier.
This technique of lifting your cheek into a neutral position can also be used to make talking easier for others to understand if your speech is sometimes slurred.
DO NOT attempt to carry out facial exercises without professional guidance.
Initially following your surgery, it is important to allow the facial nerves to rest. The aim is for symmetry of your face at rest, relaxing your unaffected side as able. You may find using a mirror helps with this.
You can complete gentle upward directed massage around your mouth/cheek but you should not do any specific facial exercises. Also chewing gum repetitively will not assist in strengthening the weak muscles but can overstimulate the strong side of your face.
Continued facial weakness is reviewed at your follow up appointment with your consultant and treatment options will be discussed at this point in time. Massage may help to improve sensation and can also be beneficial in reducing pain or allowing muscles to relax. Circular strokes can be used during a facial massage, performed using the fingertips or thumbs using varied pressure, this can aid circulation and reduce tightness or tension within the facial area.
Please refer to Facial Palsy UK website for a video demonstrating facial massage techniques.
Fatigue management
It is likely that you will be tired for many weeks after your surgery. It may be useful to take naps in the afternoon and gradually increase the level of activity until your energy returns. Take short walks around the house or outdoors and gradually increase the length of your walks over the first few weeks following discharge home.
Balance/vestibular management
It is very common for you to experience some problems with dizziness and balance following the surgery as your vestibular system, which helps maintain your balance, has been affected. Vestibular compensation is a process which allows the brain to adjust so that dizziness and blurred vision can settle and balance is regained. The brain learns to cope with confusing signals coming from the affected vestibular system and relies more on sensory information from vision, legs and neck to maintain balance.
Your physiotherapist will assess you during your inpatient stay and provide you with exercises to assist in regaining your balance and compensating for your vestibular problems.
Vestibular ocular reflex exercises
The vestibular ocular reflex (VOR) is a reflex eye movement that gives the ability to focus on a stationary object while the head is moving. For example, being able to read a street sign when walking.
When the vestibular system is disrupted information regarding head position can be affected and therefore the compensating eye movements are slower to occur.
VOR or gaze stabilisation exercises aim to train the movements of the eyes to be independent of head movement. This will help to reduce dizziness experienced during movement and help improve your balance.
Exercise programme
Your physiotherapist will instruct you on the starting position and card to use to do the exercises initially. This is usually using the plain white background card in sitting.
Complete each exercise: 5-20 times or for 1 minute
If your symptoms (e.g dizziness, blurred vision etc) start to occur you should stop at that point and rest.
Repeat the process: 3-4 times for each exercise
Complete all the exercises up to: 4 times per day
Exercise progression
These exercises will provoke your symptoms
- Only progress the exercises (change card or position) once you can complete all exercises without experiencing any symptoms over 1 minute. This may take days or weeks to achieve
- Never change the card used AND position when progressing Progress to:
- Coloured background but remain sitting OR standing but keep using the plain background card
- Only change one aspect at a time
Progress is a very individual thing and it may take some time for you to notice improvement.
It is important not to give up on the exercises and to continue to progress these as you are able.
Exercise safety advice
- Remember to be careful when completing the exercises as they will bring on your symptoms
- Carry out standing exercises in flat shoes or bare feet. Heels should not be worn
- When first completing the exercises in standing have someone to support/supervise in case you lose your balance
- Progress the exercises as directed when they do NOT provoke your symptoms
- Do not rush the exercises; dedicate time to do them properly
VOR Exercise cards
Exercise diary
Please fill in your exercise diary every time you complete your exercises. This will help you and your physiotherapist to assess your progress.
Follow up
If required, you will have a telephone call from the Basal Skull Specialist Nurse 2 weeks after discharge to ensure you are recovering well.
You will be seen in outpatient clinic at Salford Royal Hospital by your Consultant approximately 6-8 weeks post-operatively.
You will be referred locally for follow up to progress your vestibular rehab exercises and to improve your balance. This will be discussed between you and your physiotherapist before discharge.
Contact Information
If you have any queries, please contact Physiotherapy on 0161 206 5332.
Further Information
BASIC (Brain and spinal injuries charity)
This is a specialist resource for patients and families affected by neurological diagnosis.
Telephone: 0161 707 6441
Website: www.basiccharity.org.uk
BANA (British Acoustic Neuroma Association)
This site was developed by people affected by acoustic neuroma and offers information and support to patients and families.
Telephone: 01246 550011
Website: www.bana-uk.com
RNID (Royal National Institute for the Deaf)
This site can offer help and advice to people with hearing difficulties and deafness.
Telephone: 0808 8080 123
Website: www.rnid.org.uk
Facial Palsy UK
This is a charity set up to support patients with facial palsy. Telephone: 0300 030 9333
Website: www.facialpalsy.org.uk
Date of Review: January 2025
Date of Next Review: January 2027
Ref No: PI_SU_1351 (Salford)