Ninev Karl Zia looks forward to his adventure vacations. In his early 50s, Zia enjoys biking, mountain trail hiking and boating. In 2014, he had even learned to scuba dive. Then he started noticing problems with the hearing in his right ear.
Zia consulted his primary care physician, who attributed his minor hearing loss to the normal aging process. But when it continued to get worse, he went back. This time, audiologic testing revealed that he had completely lost certain frequencies. “I was hearing strange noises – water sounds, squeaks. I called it my ‘zoo’ of noises. My PCP recognized this as a possible symptom of acoustic neuroma.”
An MRI revealed a 8-millimeter acoustic neuroma, small enough to wait for surgery. Zia returned in six months for observation but the tumor was continuing to grow. “It’s an anguishing decision,” he said. “In my research, I learned that the longer you wait, the more risk there is for facial nerve damage and other complications when you do have the surgery.”
Zia reached out to the online acoustic neuroma community and found a wealth of information. “I learned that there are only a few Centers of Excellence for AN in the country and that the Vanderbilt Skull Base Center is one of them. While it was the closest to me – a five-hour drive from my home in Indianapolis – it also came highly recommended. I wanted surgeons who had performed many of these procedures.”
At Vanderbilt, Zia met neurotologist Alejandro Rivas and neurosurgeon Reid Thompson. “I knew I was in good hands. They were so open; they had a willingness to take the time and really explain things.”
Because his tumor had grown to 1.1 centimeters and he had already lost 70% of the hearing in his right ear, the Vanderbilt surgeons decided to use the translabyrinthine surgical approach.
“With this approach, we had a very good chance of preserving Mr. Zia’s facial nerve function,” explained Rivas. “And we were successful. In translabyrinthine surgery, we go through the hearing channel, which provides the best view of the tumor; we don’t have to push on the brain stem or cerebellum.”
Zia’s care team emphasized the importance of safely and carefully re-establishing normal activities. He followed the required schedule of physical therapy and started doing frequent short walks, initially with a cane, to challenge his brain to adapt to a single remaining balance nerve. Two months after his surgery, he and his wife met friends in Yosemite for a long-planned hiking trip. And he began to think about returning to diving.
In the ANA forum, Zia encountered the broadly held recommendation that AN patients (especially translab) should not return to scuba diving because of: 1) the risk of cerebrospinal fluid leak; 2) impaired or loss of ability to equalize middle ear of the surgical side; 3) risk of vertigo brought on by temperature changes; and 4) risk of barotrauma to the only remaining hearing nerve.
“After carefully weighing the risks and experimenting for weeks in a pool, I decided to go back into the water. I started out slowly and have since gone on seven vacation dives. There’s no better testament to my surgical team’s expertise!”