Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma

Patterns of hearing loss and variables influencing audiometric decline

Matthew L. Carlson, Jeffrey T. Jacob, Bruce E. Pollock, Brian A. Neff, Nicole M. Tombers, Colin L W Driscoll, Michael J. Link

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Object. The goals of this retrospective cohort study were as follows: 1) to describe the long-term prevalence and timing of hearing deterioration following low-dose (12- to 13-Gy marginal dose) stereotactic radiosurgery (SRS) for vestibular schwannoma (VS); and 2) to identify clinical variables associated with long-term preservation of useful hearing following treatment. Methods. Patients with serviceable hearing who underwent SRS for VS between 1997 and 2002 were studied. Data including radiosurgery treatment plans, tumor characteristics, pre- and posttreatment pure tone average, speech discrimination scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class were collected. Time to nonserviceable hearing was estimated using the Kaplan-Meier method. Univariate and multivariate associations with time to nonserviceable hearing were evaluated using Cox proportional hazards regression models. Results. Forty-four patients met the study criteria and were included. The median duration of audiometric follow- up was 9.3 years. Thirty-six patients developed nonserviceable hearing at a mean of 4.2 years following SRS. The Kaplan-Meier estimated rates of serviceable hearing at 1, 3, 5, 7, and 10 years following SRS were 80%, 55%, 48%, 38%, and 23%, respectively. Multivariate analysis revealed that pretreatment ipsilateral pure tone average (p < 0.001) and tumor size (p = 0.009) were statistically significantly associated with time to nonserviceable hearing. Conclusions. Durable hearing preservation a decade after low-dose SRS for VS occurs in less than one-fourth of patients. Variables including preoperative hearing capacity and tumor size may be used to predict hearing outcomes following treatment. These findings may assist in pretreatment risk disclosure. Furthermore, these data demonstrate the importance of long-term follow-up when reporting audiometric outcomes following SRS for VS.

Original languageEnglish (US)
Pages (from-to)579-587
Number of pages9
JournalJournal of Neurosurgery
Volume118
Issue number3
DOIs
StatePublished - Mar 2013

Fingerprint

Acoustic Neuroma
Radiosurgery
Hearing Loss
Hearing
Neoplasms
Speech Perception
Disclosure
Otolaryngology
Proportional Hazards Models
Cohort Studies
Neck
Multivariate Analysis
Retrospective Studies
Head

Keywords

  • Cerebellopontine angle
  • Gamma Knife surgery
  • Hearing preservation
  • Stereotactic radiosurgery
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma : Patterns of hearing loss and variables influencing audiometric decline. / Carlson, Matthew L.; Jacob, Jeffrey T.; Pollock, Bruce E.; Neff, Brian A.; Tombers, Nicole M.; Driscoll, Colin L W; Link, Michael J.

In: Journal of Neurosurgery, Vol. 118, No. 3, 03.2013, p. 579-587.

Research output: Contribution to journalArticle

Carlson, Matthew L. ; Jacob, Jeffrey T. ; Pollock, Bruce E. ; Neff, Brian A. ; Tombers, Nicole M. ; Driscoll, Colin L W ; Link, Michael J. / Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma : Patterns of hearing loss and variables influencing audiometric decline. In: Journal of Neurosurgery. 2013 ; Vol. 118, No. 3. pp. 579-587.
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abstract = "Object. The goals of this retrospective cohort study were as follows: 1) to describe the long-term prevalence and timing of hearing deterioration following low-dose (12- to 13-Gy marginal dose) stereotactic radiosurgery (SRS) for vestibular schwannoma (VS); and 2) to identify clinical variables associated with long-term preservation of useful hearing following treatment. Methods. Patients with serviceable hearing who underwent SRS for VS between 1997 and 2002 were studied. Data including radiosurgery treatment plans, tumor characteristics, pre- and posttreatment pure tone average, speech discrimination scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class were collected. Time to nonserviceable hearing was estimated using the Kaplan-Meier method. Univariate and multivariate associations with time to nonserviceable hearing were evaluated using Cox proportional hazards regression models. Results. Forty-four patients met the study criteria and were included. The median duration of audiometric follow- up was 9.3 years. Thirty-six patients developed nonserviceable hearing at a mean of 4.2 years following SRS. The Kaplan-Meier estimated rates of serviceable hearing at 1, 3, 5, 7, and 10 years following SRS were 80{\%}, 55{\%}, 48{\%}, 38{\%}, and 23{\%}, respectively. Multivariate analysis revealed that pretreatment ipsilateral pure tone average (p < 0.001) and tumor size (p = 0.009) were statistically significantly associated with time to nonserviceable hearing. Conclusions. Durable hearing preservation a decade after low-dose SRS for VS occurs in less than one-fourth of patients. Variables including preoperative hearing capacity and tumor size may be used to predict hearing outcomes following treatment. These findings may assist in pretreatment risk disclosure. Furthermore, these data demonstrate the importance of long-term follow-up when reporting audiometric outcomes following SRS for VS.",
keywords = "Cerebellopontine angle, Gamma Knife surgery, Hearing preservation, Stereotactic radiosurgery, Vestibular schwannoma",
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T1 - Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma

T2 - Patterns of hearing loss and variables influencing audiometric decline

AU - Carlson, Matthew L.

AU - Jacob, Jeffrey T.

AU - Pollock, Bruce E.

AU - Neff, Brian A.

AU - Tombers, Nicole M.

AU - Driscoll, Colin L W

AU - Link, Michael J.

PY - 2013/3

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N2 - Object. The goals of this retrospective cohort study were as follows: 1) to describe the long-term prevalence and timing of hearing deterioration following low-dose (12- to 13-Gy marginal dose) stereotactic radiosurgery (SRS) for vestibular schwannoma (VS); and 2) to identify clinical variables associated with long-term preservation of useful hearing following treatment. Methods. Patients with serviceable hearing who underwent SRS for VS between 1997 and 2002 were studied. Data including radiosurgery treatment plans, tumor characteristics, pre- and posttreatment pure tone average, speech discrimination scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class were collected. Time to nonserviceable hearing was estimated using the Kaplan-Meier method. Univariate and multivariate associations with time to nonserviceable hearing were evaluated using Cox proportional hazards regression models. Results. Forty-four patients met the study criteria and were included. The median duration of audiometric follow- up was 9.3 years. Thirty-six patients developed nonserviceable hearing at a mean of 4.2 years following SRS. The Kaplan-Meier estimated rates of serviceable hearing at 1, 3, 5, 7, and 10 years following SRS were 80%, 55%, 48%, 38%, and 23%, respectively. Multivariate analysis revealed that pretreatment ipsilateral pure tone average (p < 0.001) and tumor size (p = 0.009) were statistically significantly associated with time to nonserviceable hearing. Conclusions. Durable hearing preservation a decade after low-dose SRS for VS occurs in less than one-fourth of patients. Variables including preoperative hearing capacity and tumor size may be used to predict hearing outcomes following treatment. These findings may assist in pretreatment risk disclosure. Furthermore, these data demonstrate the importance of long-term follow-up when reporting audiometric outcomes following SRS for VS.

AB - Object. The goals of this retrospective cohort study were as follows: 1) to describe the long-term prevalence and timing of hearing deterioration following low-dose (12- to 13-Gy marginal dose) stereotactic radiosurgery (SRS) for vestibular schwannoma (VS); and 2) to identify clinical variables associated with long-term preservation of useful hearing following treatment. Methods. Patients with serviceable hearing who underwent SRS for VS between 1997 and 2002 were studied. Data including radiosurgery treatment plans, tumor characteristics, pre- and posttreatment pure tone average, speech discrimination scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class were collected. Time to nonserviceable hearing was estimated using the Kaplan-Meier method. Univariate and multivariate associations with time to nonserviceable hearing were evaluated using Cox proportional hazards regression models. Results. Forty-four patients met the study criteria and were included. The median duration of audiometric follow- up was 9.3 years. Thirty-six patients developed nonserviceable hearing at a mean of 4.2 years following SRS. The Kaplan-Meier estimated rates of serviceable hearing at 1, 3, 5, 7, and 10 years following SRS were 80%, 55%, 48%, 38%, and 23%, respectively. Multivariate analysis revealed that pretreatment ipsilateral pure tone average (p < 0.001) and tumor size (p = 0.009) were statistically significantly associated with time to nonserviceable hearing. Conclusions. Durable hearing preservation a decade after low-dose SRS for VS occurs in less than one-fourth of patients. Variables including preoperative hearing capacity and tumor size may be used to predict hearing outcomes following treatment. These findings may assist in pretreatment risk disclosure. Furthermore, these data demonstrate the importance of long-term follow-up when reporting audiometric outcomes following SRS for VS.

KW - Cerebellopontine angle

KW - Gamma Knife surgery

KW - Hearing preservation

KW - Stereotactic radiosurgery

KW - Vestibular schwannoma

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