Hearing After Vestibular Schwannoma Surgery: Is It Preserved Forever?

Abstract

Introduction: Currently, it is possible to preserve the auditory nerve in a large number of cases, but the preservation of the hearing itself is unpredictable. Apart from wait and scan strategy and stereoradiotherapy, hearing after vestibular schwannoma surgery is considered to remain stable even in long-term follow-up. Materials and Methods: Twenty-eight patients had preserved hearing after retrosigmoid suboccipital microsurgery of the vestibular schwannoma between 2008 and 2014. A standard audiological protocol was performed together with an magnetic resonance imaging evaluation of the fluid content of the inner ear. Results: The mean difference in pure-tone average between the direct and final postsurgical examination was 12.758 dB ( p = 2.5E − 06). The word recognition score deteriorated by 17.45% ( p = 0.03516). The mean American Academy of Otolaryngology-Head and Neck Surgery score on the second examination was 2.5, and that on the second examination was 3.111 ( p = 0.00483). There was no significant deterioration in the healthy ear.The signal intensity ratio in the basal turn of the cochlea increased by an average of 0.13 points ( p < 0.05). Patients with persistent tumor or nodular enhancement in the internal acoustic meatus deteriorated significantly in hearing according to the American Academy of Otolaryngology-Head and Neck Surgery scale compared with patients without any finding in the meatus ( p = 0.01299). Conclusions: There is a discrete but gradual deterioration of the hearing in the postoperative period. Hearing impairment is more pronounced in patients with a nodular process in the internal acoustic meatus, regardless of whether it is growth active. After surgery, the pathological content of the inner ear normalizes (evaluated on T2 magnetic resonance imaging sequences).

The outcome of the retrosigmoid approach in the decompression of vestibular schwannomas – a retrospective cohort study of 60 consecutive cases

“…Other authors found that serviceable hearing (grade A or B) was preserved in 70.4% of patients [ 15 ]. Unfortunately, this preservation of acoustic function could deteriorate with time [ 16 , 17 ]. In our study, 55 patients (91%) presented with hearing deficits after surgery, grade D hearing loss occurring in 42 patients (70%), grade C in 11 patients (18.33%), grade B in 2 patients (3.33%).…”

Establishment of Nomogram for Prediction of Hearing Preservation after Retrosigmoid Approach in Patients with Vestibular Schwannoma

“…However, due to the uncertainty of the growth trend of VS and the vari-ability of patients' symptoms (4), the decisions regarding surgical timing as well as surgical approach are difficult to make. Although some previous studies have demonstrated that preoperative hearing, tumor size, cerebrospinal fluid between the lateral tumor margin and the fundus of the internal auditory canal (IAC), and so on seem to be related to postoperative hearing preservation (HP) (5)(6)(7), other different results have been reported continuously (8). In short, there is a lack of an accurate prediction system and clinical decision-making strategy that takes cochlear nerve function preservation as the primary consideration.…”