Hearing Improvement in a Vestibular Schwannoma Patient Undergoing Wait-and-Scan Management

Vestibular schwannomas are benign tumors originating from Schwann cells of the 8 cranial nerve. Patients with vestibular schwannoma most commonly present with hearing loss, followed by tinnitus and disequilibrium. We report the case of a 73-year-old gentleman who initially presented with an asymmetric hearing loss and was subsequently diagnosed to have a unilateral vestibular schwannoma. The patient elected to proceed with a wait-and-scan management approach. During his follow-up period, imaging showed there was limited growth of the tumor with solidification of a cystic component of the tumor. Notably, during the same period, his high-frequency sensorineural hearing loss (SNHL) worsened to a severe SNHL in all frequencies with very poor speech discrimination. At subsequent 1-year follow-up, his hearing had improved to a serviceable hearing level. While the natural history of vestibular schwannoma suggests hearing loss over time, this case highlights the variable nature of hearing changes, including slow decline, sudden hearing loss, and even some return of hearing function. This report underscores the potential for hearing recovery in conservatively managed vestibular schwannoma with implications for hearing rehabilitation and patient-centered decision-making.