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. 2010 Sep;31(7):1144-52.
doi: 10.1097/MAO.0b013e3181edb8b2.

Long-term hearing preservation after microsurgical excision of vestibular schwannoma

Erika Ann Woodson  1 , Ryan Douglas Dempewolf, Samuel Paul Gubbels, Aaron Thomas Porter, Jacob Jay Oleson, Marlan Rex Hansen, Bruce Jay Gantz
Affiliations

Long-term hearing preservation after microsurgical excision of vestibular schwannoma

Erika Ann Woodson et al. Otol Neurotol. 2010 Sep.

Abstract

Objective: To examine long-term hearing outcomes after microsurgical excision of vestibular schwannoma (VS).

Study design: Retrospective case review.

Setting: Tertiary referral center.

Patients: Forty-nine subjects at a single institution who had undergone microsurgical excision of a VS via middle cranial fossa (MCF) approach between 1994 and 2007 with immediate postoperative (PO) hearing preservation and for whom long-term audiograms were available.

Intervention: Diagnostic.

Main outcome measures: Word Recognition Score (WRS) is defined by speech discrimination scores (SDS) greater than 70% (grade I), 50% to 70% (grade II), less than 50% (grade III), and 0% (grade IV).

Results: For subjects with more than 2 years of follow-up, WRS I hearing was present PO in 42 of 49 patients and was preserved at the latest follow-up in 38 (90%) of 42 patients. No subjects fell beyond WRS II. WRS I hearing was maintained in 23 (88%) of 26 patients with more than 5 years of follow-up. Postoperative WRS I to II hearing was maintained in 28 (96%) of 29 patients with more than 5 years of follow-up. The patient who lost significant hearing in the ear operated on had sensorineural hearing loss that paralleled deterioration in her ear that was not operated on.

Conclusion: Most subjects maintain their initial PO SDS after microsurgical VS removal, and therefore, the initial PO WRS is predictive of long-term hearing. Postsurgical changes do not alter the natural rate or pattern of progressive bilateral sensorineural hearing loss in individual subjects.

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Figures

FIG. 1
FIG. 1
Speech discrimination score changes over time.
FIG. 2
FIG. 2
Word Recognition Score hearing results. A, Initial PO hearing results, SDS plotted versus 4-tone PTA, on the WRS grading scale (22). B, Hearing results at the latest follow-up (mean, 70.5 mo) on the WRS grading scale.
FIG. 3
FIG. 3
Kaplan-Meier survival curves for preservation of serviceable hearing. The patient with bilateral sensorineural hearing loss was excluded. A, Preservation of serviceable (WRS I–II) hearing over time of patients with PO WRS I to II hearing. B, Preservation of serviceable (AAO-HNSc A–B) hearing over time of patients with PO AAO-HNS A to B hearing. Dashed lines indicate SE (0.31).
FIG. 4
FIG. 4
The AAO-HNS hearing results. A, Initial PO hearing results, SDS plotted versus 4-tone PTA, on the AAO-HNS grading scale (33). B, Hearing results at the latest follow-up (mean, 70.5 mo) on the AAO-HNS grading scale (noncorrected for changes in the ear not operated on). C, Hearing results at the latest follow-up on the AAO-HNSc grading scale (corrected for changes in the ear not operated on).
FIG. 5
FIG. 5
Iowa algorithm for management of small VS.
See this image and copyright information in PMC

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