Hearing Preservation Outcomes and Prognostic Factors in Acoustic Neuroma Surgery: Predicting Cutoffs

Abstract

Objective: To investigate the outcomes of hearing preservation surgery (HPS) for acoustic neuroma and quantify tumor and patient characteristics predictive of hearing preservation after surgery. Study Design: Retrospective study. Setting: Tertiary referral center. Patients: A total of 100 consecutive patients diagnosed with acoustic neuroma from 2000 to 2012. Intervention: Hearing preservation surgery through microscopic retrosigmoid approach combined with a retrolabyrinthine meatotomy. Main Outcome Measure: Pre-and postoperative hearing stratified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Tokyo classifications. The most accurate cutoff was identified for each tumor and patients' variable affecting the outcome by calculating the Youden index. A multivariable analysis was undertaken at these cutoffs to identify prognostic factors for hearing preservation. Results: Preoperative hearing class was preserved after surgery in 31% (AAO-HNS), and 39% (Tokyo classification) of patients. According to the AAO-HNS classification, the tumor size in the cerebello-pontine angle, pure-tone average (PTA), and speech discrimination score cutoffs for predicting good postoperative hearing function were 7 mm, 21 dB, and 90%, respectively. With the Tokyo classification, only the PTA cutoff differed, with 27 dB. On multivariable analysis, tumor size and PTA were independent prognostic factors for postoperative hearing with high model's goodness of fit (area under the curve ¼ 0.784; 95% CI ¼ 0.68-0.88 and area under the curve ¼ 0.813; 95% CI ¼ 0.72-0.90), according to both the hearing classifications. Conclusions: The estimated cutoffs for tumor size and PTA were independently associated with HPS. These factors should be prospectively investigated before they are adopted as selection criteria for HPS.

Management of Vestibular Schwannoma with Normal Hearing

“…When ABR abnormality increased postoperative hearing worsened (p = 0.001). In agreement with other authors [Brackmann et al, 2000;Zanoletti et al, 2020], type 5 ABR was associated with a poorer postoperative hearing. All the cases with postoperative anacusis had a preoperative abnormal ABR, mostly type 5.…”

“…There is a consensus in the literature that the most prognostic indicators for successful HP are tumor size <10 mm, good preoperative hearing and high speech discrimination score (SDS), shorter hearing loss period, and tumors from SVN [Bakkouri et al, 2009;Carlson et al, 2018;Huo et al, 2019]. In addition, there is some evidence that the auditory brainstem response (ABR) can provide prognostic information on prospects of HP [Brackmann et al, 2000;Hosoya et al, 2019;Zanoletti et al, 2020], since the ABR depends on neural synchrony and centripetal auditory-pathway integrity. The aim of the present work was to define an appropriate algorithm for the management of VS in a patient with NH can be diagnosed.…”

Cochlear Implantation Following Transcanal Infrapromontorial Approach for Vestibular Schwannoma: A Case Series

“…Several studies over the last ten years reported that cochlear implantation could safely be performed simultaneously with VS resection if the cochlear nerve was anatomically preserved and no overly aggressive manoeuvres were applied to remove the tumour. In addition to nerve preservation, audiological outcomes depended on tumour size in CPA and residual hearing function on the affected side [ 20 , 21 ]. Although a long-standing debate, an additional role may be played by a better contralateral hearing ear.…”

Applicability of contemporary quality indicators in vestibular surgery—do they accurately measure tumor inherent postoperative complications of vestibular schwannomas?

“…Tumor size and previous radiotherapy were identified as risk factors for hearing loss in our collective. In addition, impaired preoperative hearing has been found as a risk factor [ 5 , 57 ]. These variables should be considered for preoperative risk adjustment.…”