Hearing Outcomes in Conservatively Managed Vestibular Schwannoma Patients With Serviceable Hearing

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Abstract

Objective:

To characterize the risk of progression to nonserviceable hearing in patients with sporadic vestibular schwannomas (VS) who elect initial observation.

Study Design:

Retrospective case series.

Setting:

Two tertiary care centers.

Patients:

VS patients with serviceable hearing who underwent at least two audiograms and two MRI studies before intervention or loss to follow-up.

Main outcome measure(s):

Serviceable hearing, defined as the pure tone average ≤ 50 dB HL and word recognition score ≥ 50%.

Results:

Four-hundred sixty-six patients (median age of 57 yr and median tumor diameter of 7.3 mm) had serviceable hearing at presentation and were followed for a median of 2.3 years (IQR 1.0 – 4.0). Kaplan–Meier estimated rates of maintaining serviceable hearing (95% CI; number still at risk) at 1, 3, 5, 7, and 10 years following diagnosis were 94% (91–96; 357), 77% (73–82; 172), 66% (60–73; 81), 56% (49–65; 31), and 44% (33–59; 10), respectively. Each 10-dB increase in pure-tone averages at diagnosis was associated with a 2-fold increased likelihood of developing nonserviceable hearing (hazard ratio 2.07; p < 0.001). Each 10% decrease in word recognition score was associated with a 1.5-fold increased likelihood of developing nonserviceable hearing (hazard ratio 1.48; p < 0.001).

Conclusions:

Among patients with sporadic VS, good baseline word recognition score and low pure-tone average are jointly associated with maintenance of serviceable hearing. These data may be used to guide patient counseling and optimize management.

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