Durability of Hearing Preservation Following Microsurgical Resection of Vestibular Schwannoma

Eric M. Dowling, Neil S. Patel, Christine M. Lohse, Colin L.W. Driscoll, Brian A. Neff, Jamie J. Van Gompel, Michael Link, Matthew L. Carlson

Research output: Contribution to journalArticle

Abstract

Objective:To ascertain long-term hearing outcomes in patients with serviceable hearing following microsurgical resection of sporadic vestibular schwannoma (VS).Study Design:Retrospective cohort.Setting:Tertiary academic referral center.Patients:Forty-three adult subjects with unilateral sporadic VS who had serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS] class A or B) on initial postoperative audiogram following microsurgical resection between 2003 and 2016 with a minimum of two postoperative audiograms available for review.Intervention:Surgical treatment with a retrosigmoid or middle cranial fossa approach.Main Outcome Measure:Rate of maintaining serviceable hearing, as estimated using the Kaplan-Meier method, in accordance with the 1995 and 2012 AAO-HNS guidelines on reporting hearing outcomes.Results:The median immediate postoperative pure-tone average (PTA) and word recognition score (WRS) were 31dB and 95%, respectively. At last follow-up, the median PTA was 38dB with a median change of 5dB from initial postoperative audiogram, and the median WRS was 90% with a median change of 0% from initial postoperative audiogram. Eight patients developed non-serviceable hearing at a median of 4.1 years following microsurgical resection (interquartile range, 2.9-7.0). The median duration of hearing follow-up for the 35 patients who maintained serviceable hearing was 3.1 years (interquartile range, 2.2-7.5). Tumor control was achieved in 41 (95%) patients. The rate of maintaining serviceable hearing at 5 years was 81%.Conclusion:Microsurgical resection provides excellent tumor control and durable long-term hearing in those with AAO-HNS class A or B hearing postoperatively. The paradigm of proactive microsurgical resection - when the tumor is small and hearing is good - hinges on the surgeon's ability to preserve residual hearing in a very high percentage of cases at or near preoperative hearing levels to maintain an advantage over conservative observation with regard to long-term hearing preservation.

Original languageEnglish (US)
Pages (from-to)1363-1372
Number of pages10
JournalOtology and Neurotology
Volume40
Issue number10
DOIs
StatePublished - Dec 1 2019

Keywords

  • Acoustic neuroma
  • Neurotology
  • Skull base
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Durability of Hearing Preservation Following Microsurgical Resection of Vestibular Schwannoma'. Together they form a unique fingerprint.

  • Cite this

    Dowling, E. M., Patel, N. S., Lohse, C. M., Driscoll, C. L. W., Neff, B. A., Van Gompel, J. J., Link, M., & Carlson, M. L. (2019). Durability of Hearing Preservation Following Microsurgical Resection of Vestibular Schwannoma. Otology and Neurotology, 40(10), 1363-1372. https://doi.org/10.1097/MAO.0000000000002378