For many people living with acoustic neuroma, balance problems are harder to explain than hearing loss, but often far more disruptive. They rarely begin with dramatic spinning. Instead, they creep in quietly.
You walk and feel as if the ground is slightly tilted. You drift to one side without meaning to. You hesitate before stepping off a curb. You bump into door frames. Some days, it feels like you are walking like a drunk person, even though you are completely sober.
Others may not notice. You do. And that disconnect can be deeply isolating.
Because balance problems are invisible, they are often misunderstood. By family, by colleagues, and sometimes even by clinicians early on. Patients are told it is anxiety, lack of confidence, or simply getting older. In reality, balance problems in acoustic neuroma are neurological, mechanical, and exhausting. Understanding why they happen can reduce fear, self-blame, and unrealistic expectations during recovery.
Why Balance Is Affected
Acoustic neuromas arise from Schwann cells on the vestibular portion of the eighth cranial nerve. This nerve carries balance information from the inner ear to the brain.
In a healthy system, the brain receives equal and opposite balance signals from both ears. This symmetry allows you to stand still, walk straight, and turn your head without thinking about it. Balance feels automatic because the signals match.
A tumour breaks that symmetry. As it grows, it compresses the balance nerve on one side, weakening or distorting the signal. The other ear continues to send normal information. The brain is left trying to reconcile two conflicting messages.
It interprets this mismatch as movement.
That is why people feel unsteady even when standing still. Why walking in a straight line suddenly requires concentration. Why turning quickly feels disorienting. Why fatigue makes everything worse.
Balance problems usually show up in two overlapping ways.
Some are static. Standing still feels uncomfortable. You may sway, lean, or feel as if you are about to tip over, particularly when your eyes are closed or the lighting is poor.
Others are dynamic. When you move your head, your eyes are meant to stabilise your vision instantly. When this reflex fails, the world blurs during movement. Reading signs while walking becomes difficult. Supermarkets feel overwhelming. This is known as oscillopsia and is one of the main reasons patients struggle in busy environments.
In larger tumours, balance issues can become more severe. Pressure on the cerebellum or brainstem interferes with coordination itself. Walking may become wide-based and clumsy. People often describe it as feeling disconnected from their legs, or as if their body reacts half a second too late. The risk of falls increases significantly.
How the Brain Tries to Adapt: Central Compensation
The brain does not passively accept vestibular damage. It tries to adapt. This process is called central compensation.
When balance input changes suddenly, such as after surgical removal of the tumour and balance nerve, the brain initially suppresses signals from the healthy ear. This temporary shutdown helps stop violent spinning sensations. It also explains why the first few days after surgery are often the most debilitating.
As this suppression eases, the brain begins to rely more heavily on other systems. Vision takes on a bigger role. Proprioception, the sense of pressure and position from your feet and joints, becomes critical. Many patients notice they walk better when looking at the ground or when wearing firm shoes that give strong sensory feedback.
Over weeks and months, deeper changes take place. The brainstem recalibrates. New pathways strengthen. Gradually, walking becomes less effortful. Turning feels safer. Confidence begins to return.
This process depends on movement. The brain learns through error. Avoiding movement may feel protective, but it slows adaptation. Gentle, repeated exposure is what teaches the brain how to rebalance.
Gentamicin Injections: Preparing the Brain Before Surgery
In some cases, doctors may recommend gentamicin injections into the inner ear before surgery. Gentamicin is an antibiotic that is deliberately used here for its toxic effect on the balance organ.
The aim is to gradually destroy the remaining balance function on the affected side in a controlled way, rather than allowing it to be lost suddenly during surgery.
The logic is straightforward. Sudden loss of balance input can overwhelm the brain and lead to severe vertigo and prolonged recovery. Gentamicin injections allow the brain to begin central compensation before surgery takes place. In effect, the body is given time to adjust to a one-sided balance system in advance.
During treatment, patients may feel a temporary worsening of dizziness as the balance nerve is intentionally shut down. This period can be unpleasant, but it gives the brain a head start. The change after surgery is less abrupt and often easier to manage.
Gentamicin is not a cure, and it does not replace rehabilitation. What it offers is preparation. Time for the brain to start adapting before the surgical disruption occurs.
Why Balance Often Fluctuates Long Term
Even with good compensation, balance is rarely restored to what it was before.
Long-term studies show that a significant minority of patients continue to experience imbalance years after treatment. Many describe a persistent drunk-like walk, particularly when tired, stressed, or unwell. Others feel steady at home but struggle badly in supermarkets, airports, or crowded streets.
Some patients experience what is often called decompensation. Balance worsens months or years later, not because the tumour has returned, but because the brain’s compensatory strategies are fragile. Illness, fatigue, poor sleep, anxiety, or ageing can overwhelm them.
This is why balance can feel unpredictable. One week you walk confidently. The next, you are holding onto walls again. This does not mean you are going backwards. It usually means your system is overloaded.
Balance problems also have a disproportionate impact on quality of life. More than hearing loss, they affect confidence, independence, and social engagement. Constantly monitoring how you walk, where you step, and how fast you move is mentally exhausting. Many people withdraw socially, not because they cannot walk, but because they are tired of managing it.
This is not weakness. It is neurological workload.
Vestibular Rehabilitation Therapy: Training the Brain to Rebalance
Vestibular rehabilitation therapy is one of the most effective tools for managing balance problems in acoustic neuroma. It is not reassurance therapy. It is structured brain retraining.
Most programmes focus on three areas.
Gaze stabilisation exercises retrain the eyes to stay fixed on a target while the head moves.
Habituation exercises repeatedly expose the brain to movements that trigger dizziness, gradually reducing sensitivity.
Balance retraining deliberately challenges stability, often using uneven or unstable surfaces, forcing the brain to refine its use of sensory input from the body.
These exercises are uncomfortable by design. Progress does not come from pushing harder, but from showing up consistently. When done properly, they reduce long-term disability and improve confidence, even if balance is never perfect.
Living with an unsteady body
Balance recovery after acoustic neuroma is rarely neat or linear. Some days you walk normally. Other days you feel as if you have had one drink too many, even though you have not touched alcohol.
That does not mean you are failing.
What improves is function. Awareness. The ability to move through the world without constant fear.
Understanding what is happening matters. Struggle does not mean damage. Fluctuation does not mean decline. And effort, even when no one can see it, is doing real neurological work.
Balance does not return simply because time passes.
It returns because the brain is forced to adapt.
And in acoustic neuroma, adaptation is an ongoing, active process.
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If you live with balance problems due to acoustic neuroma, you are not alone.
What situations make your balance worse? Fatigue, crowds, low light?
Share your experience in the comments. It helps others feel less isolated.
Thank you so much for writing this in one article – after a huge acoustic neuroma tumour removal in 2021 I never fully understood why my body behaves as it does so this is a massive comfort as I relate to all of this – supermarkets, airports etc are definitely a big challenge for me
I’m so glad this article has been written. I, too, have a very large tumour removed after months of being told by an ENT there was nothing wrong with me. When my face went sideways and my left eye got stuck open, A professor from
the UBC hospital took over my case and got my into the brain surgeon and 23 hours later and 9 months later the tumour was removed. My recovery was very difficult as Covid was happening and I was so very tired . I really don’t appreciate the balance changes that are now a part of my life . I’m finally going to see a therapist to help me with my balance, anxiety.
I can relate to all of this I even got accused by a passer by of having one too many because of my balance. My AN of 5cm was removed in May 2023 although I have come a long way since then still have good days and bad days.
For this 89 guy , 43 yr post AN, balance continues to worsen. I refuse to give up and drive myself to play tennis/sail and yes today with new snow even ⛷️ ski. Sur tough with resulting eye issue but ok if slow under control. Push push yourselves.
I can relate totally to this article. Diagnosed in 2010 and still on watch and wait as tumor stable. My brain has adapted in many ways, but I’m less confident outside than in. When tired, anxious symptoms are much worse. At home I’m more confident. Some days/weeks it’s much easier, other times I feel I’ve gone backwards. I always walk with a stick after falling over and bruising my ribs. But I remain positive and determined to do as much as I can on the good days.
Yes! Keep up the hard work! Love your attitude! See. my story below!
Thanks for article…it encompasses much of what I went through pre and post surgery. When I came home from the hospital (week stay) I immediately started my yoga routine along with strength exercises (body and light weights) at home. Forced myself to walk longer each day and eventually got back on my mountain bike and in the pool. The repetitive motion of head turning/re-focusing while lap swimming in the dark, getting out with a head-lamp, flashlight while walking on uneven terrain, and re-training my brain to adapt to bumps and car lights on my mountain bike has helped me function in my daily life (driving, shopping, etc) much more easily. I am convinced you HAVE to engage in the behaviors that are uncomfortable and challenging to improve and re-wire the brain. I am 72 and had surgery almost three years ago (this Feb) and have competed in two multisports events, two open water swims and two mountain bike races in the last 3 years….more to come!
This article explains things so well-I will be sharing it! In 2015, my PCP ordered a brain scan after a year of allergy and assorted other testing yielded no clues to my facial numbness and a burning feeling in and around my mouth. I was diagnosed with a large AN, so I chose a hospital and surgical team where AN surgery was performed on a daily basis. I knew going in I would have complete hearing loss in my right ear, but was totally unprepared for the huge impact it would have on my daily life. I had a fairly uneventful recovery, but I did experience all the balance issues and received vestibular rehab for several weeks. Just as problematic were large venues, inability to locate where sounds/voices were coming from, and not being able to follow or participate in simple conversations. Luckily the only vertigo I experience happens very briefly and at the change of seasons, I had given up being a member of any audience, and I don’t enjoy walking as it takes too much concentration. I was getting discouraged rather than accustomed to my new norm. A short term beginner Tai Chi class offered at my local library has been the best thing for my balance and self-confidence. I plan on finding a local class or an online one. A new hearing aid boosts my aging ‘good’ ear enough to enjoy being out with friends again. Closed captioning on TV and at the movie theater are critical for me. My AN issues won’t get better, but I’m finding ways to deal better with them,
I appreciate this article–it’s a great summary of the experience. My balance problems are on the milder end of the spectrum but they’re still frustrating. I do vestibular exercises every morning, try to swim a couple times a week, and have started getting on the tennis court (I’m 1 1./2 years post SRS), and I haven’t lost hope that my condition will improve, but I’m not holding my breath. There’s an uneven flagstone walkway from the sidewalk to my front door, and this is where I find the sensations of unsteadiness and lack of balance to be consistently the most noticeable–it’s especially bad at night, when the walkway is dark, but it’s bad during the day too. And the unevenness isn’t that extreme–the stones may be only a few degrees away from complete flat–but I may as well be on a boat in rough water!