Acoustic neuroma surgery: the results of long-term hearing preservation

Abstract

Objective: To report the long-term outcome hearing results following acoustic neuroma surgery. To determine whether changes, if any, in the thresholds of the operated ear are mirrored in the contralateral unoperated side. In addition, to identify predictive factors, if any, that may predispose individuals to hearing loss in the operated ear in the late post-operative period.

Study design: Retrospective patient chart review.

Setting: University Tertiary Referral Centre.

Patients: From 1978 to 1997, one hundred and twenty six patients with small acoustic neuromas (less than 2 cm as measured within in the cerebellopontine angle) underwent excision via the suboccipital (retrosigmoid) approach with the patient in the prone position. Hearing preservation was successful in 43 patients (34.1%). The audiometric data of thirty patients with a minimum follow-up interval of 36 months was analyzed. The mean follow-up period was 113.4 months (range 36-264, SD=57.8) and the mean age at surgery was 47.3 years (range 32 to 64, SD = 7.3).

Outcome measures: Speech Reception Thresholds (SRT), Speech Discrimination Scores (SDS) and Pure-tone Audiometry (PTA, 0.5, 1 & 2 kHz) were noted on the operated and unoperated ears. The AAO Classification according to the Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma was used to assess hearing serviceability.

Results: Subsequent to including corresponding changes in the unoperated ear, the means of the SRT and PTA in the operated ear between the early and late post-operative periods were statistically significantly different (p=0.0012 & 0.034 respectively). Twelve (40%) patients demonstrated significant deterioration in hearing thresholds over time. Pre-operatively, 96.7% of patients had serviceable hearing (Class A & B). This falls to 76.6% in the early post-operative period and to 56.7% in the late post-operative period.

Conclusion: Our study highlights the finding that over time a significant number of individuals realize a greater ongoing hearing loss in the post tumour excision ear than the contralateral ear.