Change in hearing and tinnitus in conservatively managed vestibular schwannomas

The aim of this study was to evaluate the change of hearing and tinnitus in a group of conservatively managed unilateral vestibular schwannomas (VS).

Retrospective case series review.

Tertiary referral otoneurological and skull base surgery department.

Seventy patients affected by unilateral VS with at least two audiograms available were retrospectively evaluated.

Changes in pure tone average (PTA), speech discrimination score (SDS), and tinnitus were analyzed.

At diagnosis 16 patients (22.9%) had a PTA of 0 to 30 dB and 38 (54.4%) a PTA of 0 to 50 dB. At the end of the follow-up period, 9 patients (12.9%) had a PTA of 0 to 30 dB and 27 (38.7%) had a PTA of 0 to 50 dB, representing a hearing preservation rate of 56% and 70%, respectively. Of patients with both tonal and speech audiometry, 71.4% with class A hearing (PTA < 30 dB/SDS > 70%) maintained their initial hearing and 60% with class A or B hearing (PTA < 50 dB/SDS > 50%) maintained this useful hearing. Forty-two patients (60%) did not show a significant growth in their tumor over the period of observation. In this group of patients the mean PTA after a mean follow-up time of 40 months decreased from 44 dB HL to 50.8 dB HL, with a yearly rate of 2.47 dB HL. The chance of maintaining a PTA of 0 to 30 dB in this group of patients was 57.1% and a PTA of 0 to 50 dB was 81.4%.

In this group of patients affected by VS and managed conservatively with a mean follow-up of 33.3 months, the risk of losing eligibility for hearing preservation surgery was lower than 30%.