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. 2019 Nov;161(5):846-851.
doi: 10.1177/0194599819860831. Epub 2019 Jul 16.

Long-term Effects of Conservative Management of Vestibular Schwannoma on Dizziness, Balance, and Caloric Function

Kathrin Skorpa Nilsen  1   2   3 , Morten Lund-Johansen  3   4 , Stein Helge Glad Nordahl  1   3 , Monica Finnkirk  4 , Frederik Kragerud Goplen  1   2   3
Affiliations

Long-term Effects of Conservative Management of Vestibular Schwannoma on Dizziness, Balance, and Caloric Function

Kathrin Skorpa Nilsen et al. Otolaryngol Head Neck Surg. 2019 Nov.

Abstract

Objectives: To study the development of dizziness, caloric function, and postural sway during long-term observation of untreated vestibular schwannoma patients.

Study design: Retrospective review of a prospectively maintained longitudinal cohort.

Setting: Tertiary referral hospital.

Subjects and methods: Patients with vestibular schwannoma undergoing wait-and-scan management were included-specifically, those who did not require treatment during a minimum radiologic follow-up of 1 year. Baseline data and follow-up included magnetic resonance imaging, posturography, bithermal caloric tests, and a dizziness questionnaire. Main outcomes were prevalence of moderate to severe dizziness, canal paresis, and postural instability at baseline and follow-up, as compared with McNemar's test.

Results: Out of 433 consecutive patients with vestibular schwannoma, 114 did not require treatment during follow-up and were included. Median radiologic follow-up was 10.2 years (interquartile range, 4.5 years). Age ranged from 31 to 78 years (mean, 59 years; SD, 10 years; 62% women). Median tumor volume at baseline was 139 mm3 (interquartile range, 314 mm3). This did not change during follow-up (P = .446). Moderate to severe dizziness was present in 27% at baseline and 19% at follow-up (P = .077). Postural unsteadiness was present in 17% at baseline and 21% at follow-up (P = .424). Canal paresis was present in 51% at baseline and 56% at follow-up (P = .664).

Conclusions: There was no significant change in the prevalence of dizziness, postural sway, or canal paresis during conservative management of vestibular schwannoma, while tumor volume remained unchanged. This indicates a favorable prognosis in these patients with regard to vestibular symptoms.

Keywords: acoustic neuroma; balance; caloric test; conservative management; dizziness; long-term prognosis; observation; posturography; untreated; vertigo; vestibular schwannoma.

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