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Updated: Sep 2, 2025
Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss
Published on: January 25, 2016
Hearing Preservation After Intervention in Vestibular Schwannoma
Kristen L Yancey1, Samuel L Barnett2, Walter Kutz1
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center.
Objective:
This study aimed to assess the durability of audiological outcomes after radiation and surgery in the management of vestibular schwannoma.
Study Design:
Retrospective review.
Setting:
Tertiary academic center.
Patients:
Adults with sporadic vestibular schwannoma and serviceable hearing at the time of intervention.
Interventions:
Gamma Knife, middle cranial fossa, or retrosigmoid approaches.
Main Outcome Measures:
Pure-tone audiometry and speech discrimination scores.
Results:
Postintervention serviceable hearing (class A/B) was preserved in 70.4% (n = 130; mean follow-up, 3.31 yr; range, 0-15.25 yr). Of the 49 patients treated with radiation, 19 (39.6%) had serviceable hearing at last follow-up, compared with 38 (46.9% of 81) who underwent retrosigmoid (n = 36 [44.4%]) and middle cranial fossa (n = 45 [55.6%]) approaches (odds ratio [OR], 1.40; 95% confidence interval [CI], 0.67-2.82; p = 0.47). A matched analysis by age, tumor volume, and preintervention hearing (n = 38) also found no difference in hearing preservation (HP) likelihood between surgery and radiation (OR, 2.33; 95% CI, 0.24-35.91; p = 0.59). After initial HP, 4 (9.5%) surgical versus 10 (37.0%) radiated patients subsequently lost residual serviceable (A/B) hearing (OR, 0.18; 95% CI, 0.06-0.69; p = 0.01) at a mean 3.74 ± 3.58 and 4.73 ± 3.83 years after surgery and radiation, respectively. Overall, 5- and 10-year HP rates (A/B) after initially successful HP surgery were 84.4 and 63.0%, respectively. However, survival estimates declined to 48.9% at 5 years and 32.7% at 10 years when patients with immediate postoperative serviceable hearing loss were also included, which were comparable to radiation-HP rates at 5 and 10 years of 28.0 and 14.2%, respectively ( p = 0.75).
Conclusions:
After vestibular schwannoma intervention, overall HP was similar between radiated and surgical cohorts. However, when successful, surgical approaches offered more durable hearing outcomes at long-term follow-up.
