Hearing Preservation in Observed Sporadic Vestibular Schwannoma: A Systematic Review

Khandalavala, Karl R.; Saba, Elias; Kocharyan, Arminé; Daher, Ghazal S.; Lohse, Christine M.; Marinelli, John P.; Carlson, Matthew L.

doi:10.1097/mao.0000000000003520

Cited by 17 publications

(13 citation statements)

References 57 publications

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“…A recent review on 3652 patients from 26 studies, and a mean follow-up of 49.2 months demonstrated consistent patterns in progression of hearing loss during observation. The authors suggest the following benchmark for those presenting with serviceable hearing (SH) at diagnosis: approximately 75% retain SH at 3 years, 60% at 5 years, and 40% at 10 years [ 103 ].…”

Section: Resultsmentioning

confidence: 99%

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review

Sergi

Settimi

Federici

et al. 2022

JPM

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Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or microsurgical resection or wait and scan (WS). The aim of the review was to clarify which patient and tumor parameters may lead to different therapeutic choices, with a view to a personalized VS approach. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between February and March 2022. The authors defined six parameters that seemed to influence decision-making in VS management: 1-incidental VS; 2-tumor size; 3-tumor regrowth after sRT; 4-subtotal resection; 5-patients’ age; 6-symptoms. The initial search yielded 3532 articles, and finally, 812 articles were included. Through a qualitative synthesis of the included studies, management strategies were evaluated and discussed. An individualized proposal of procedures is preferable as compared to a single gold-standard approach in VS decision-making. The most significant factors that need to be considered when dealing with a VS diagnosis are age, tumor size and hearing preservation issues.

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Section: Resultsmentioning

confidence: 99%

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review

Sergi

Settimi

Federici

et al. 2022

JPM

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“…Although the dichotomic hearing outcome measure of “serviceable” versus “non‐serviceable” hearing is deemed insensitive to changes in hearing performance by the AAO‐HNS consensus, it is the most commonly used outcome metric for hearing data in vestibular schwannoma patients and therefore a current unfortunate necessity when comparing hearing across vestibular schwannoma studies 13 . A recent systematic review evaluated the survival rates for maintaining “serviceable” hearing: 96% at 1 year, 77% at 3 years, 62% at 5 years, and 42% at 10 years following diagnosis 27 . The included studies did not specifically include progressive tumors and are likely skewed towards nonprogressive tumors.…”

Section: Discussionmentioning

confidence: 99%

“…This study presents longitudinal hearing data for patients with progressive vestibular schwannomas that eventually required treatment. The majority of these patients experienced HL during observation prior to active treatment, which seems to deteriorate faster than in patients with nonprogressive tumors 7,19,26‐28 . This should be taken into account when comparing hearing results between studies, and when assessing the effect of different treatment modalities on hearing.…”

Section: Discussionmentioning

confidence: 99%

“…13 A recent systematic review evaluated the survival rates for maintaining "serviceable" hearing: 96% at 1 year, 77% at 3 years, 62% at 5 years, and 42% at 10 years following diagnosis. 27 The included studies did not specifically include progressive tumors and are likely skewed towards nonprogressive tumors. Survival rates for maintaining "serviceable" hearing were 96% at 1 year, 77% at 3 years, 62% at 5 years, and 42% at 10 years following diagnosis.…”

Section: Risk Of Losing "Serviceable" Hearingmentioning

confidence: 99%

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The Course of Hearing Loss in Patients With a Progressive Vestibular Schwannoma

Koetsier

Locher

Koot

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveThis study evaluates the natural course of hearing loss (HL) prior to treatment in patients with progressive tumors and an indication for active intervention. Evaluating this patient group specifically can put hearing outcomes after vestibular schwannoma therapy into an adequate context.Study DesignRetrospective cohort study.SettingTertiary referral center.MethodsInclusion criteria comprised unilateral vestibular schwannomas prior to active treatment, with ≥2 mm extracanalicular (EC) tumor growth and ≥2 audiograms. We performed a comprehensive assessment of hearing using multiple outcome parameters including (the annual decrease in) pure‐tone averages (PTAs; an average of 0.5, 1, 2, and 3 kHz). Predictors for HL were evaluated (patient age, tumor size/progression, follow‐up duration, baseline hearing).ResultsAt presentation, 86% of patients suffered from sensorineural HL on the affected side (≥20 dB PTA) with a median of 39 dB (interquartile rate [IQR]: 27‐51 dB). The median follow‐up duration was 21 months (IQR: 13‐34 months), after which 58% (187/322) of patients experienced progressive HL (≥10 dB), with a median increase of 6.4 dB/year. At the last follow‐up, the median PTA was 56 dB (IQR: 37‐73). Median speech discrimination scores deteriorated from 90% (IQR: 70%‐100%) to 65% (IQR: 35%‐100%). Tumor progression (maximal EC diameter) was significantly correlated to the progression of sensorineural HL, corrected for follow‐up (F(2,228) = 10.4, p < .001, R2 = 8%).ConclusionThe majority of patients (58%) with radiologically confirmed progressive vestibular schwannomas experience progressive sensorineural HL during observation. Tumor progression rate, EC tumor extension, and longer follow‐up are factors associated with more sensorineural HL.

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“…Other factors that may also play a role in some cases include cochlear fibrosis/ossification or cochlear nucleus (brainstem) trauma. Experience in acoustic hearing preservation indicates that the primary risk to hearing occurs immediately with surgery but is protracted with radiosurgery or observation (19)(20)(21). It will be interesting to see if longer follow-up in the radiosurgery and observation cohorts shows delayed deterioration in performance.…”

Section: Discussionmentioning

confidence: 99%

Cochlear Implant Outcomes between Patients with Sporadic and Neurofibromatosis Type 2–Associated Vestibular Schwannoma

et al. 2023

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Objective Compare cochlear implant (CI) performance between patients with ipsilateral sporadic vestibular schwannoma (VS) and NF2-related schwannomatosis (NF2). Compare CI performance according to VS management modality. Study Design Historical cohort. Setting Tertiary academic center. Patients Forty-nine patients (52 ears) undergoing cochlear implantation in the setting of ipsilateral sporadic (n = 21) or NF2-associated VS (n = 28). Interventions CI ipsilateral to VS. Main Outcome Measures Auditory thresholds, consonant–nucleus–consonant (CNC) word scores, and AzBio sentences in quiet scores. Results Among all patients, median post-CI pure tone average was 28 dB HL (interquartile range [IQR], 21–38), CNC word score was 39% (IQR, 6–62), and AzBio sentences in quiet score was 60% (IQR, 11–83) at a median of 12.5 months postimplantation. Despite the NF2 cohort having larger tumors, when comparing patients with sporadic versus NF2-associated VS, there were no statistically significant differences in CNC word (49% [30–70] vs. 31% [0–52]) or AzBio sentences in quiet (66% [28–80] vs. 57% [5–83]) scores. Regardless of NF2 status, all patients managed with observation, and radiosurgery achieved open-set speech. In patients who underwent microsurgery, 6 (46%) of 13 with NF2 achieved open-set speech recognition compared with 4 (67%) of 6 with sporadic disease. Conclusion Select patients with VS achieve successful hearing rehabilitation with a CI. In this cohort, tumor management strategy significantly influenced CI performance, whereas differences in NF2 status exhibited less effect. Specifically, all patients managed with observation or radiosurgery achieved open-set speech perception, whereas approximately half of people with NF2-related VS and two-thirds of people with sporadic VS achieved this outcome after tumor microsurgery. When disease permits, observation and radiosurgery should be considered in patients who may later pursue a CI.

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Hearing Preservation in Observed Sporadic Vestibular Schwannoma: A Systematic Review

Cited by 17 publications

References 57 publications

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review

The Course of Hearing Loss in Patients With a Progressive Vestibular Schwannoma

Cochlear Implant Outcomes between Patients with Sporadic and Neurofibromatosis Type 2–Associated Vestibular Schwannoma

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