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Prognostic Factors for Hearing Preservation in Vestibular Schwannoma Surgery

Brackmann, Derald E.*; Owens, Robert M.; Friedman, Rick A.*; Hitselberger, William E.; De la Cruz, Anthony*; House, John W.*; Nelson, Ralph A.*; Luxford, William M.*; Slattery, William H. III*; Fayad, Jose N.§

Tumors of the Ear and Cranial Base

Objective To determine whether prognostic indicators for hearing preservation could be identified in patients with vestibular schwannoma undergoing middle fossa craniotomy resection.

Study Design Prospective case review.

Setting Private practice tertiary referral center.

Patients 333 patients with serviceable hearing and vestibular schwannoma resected by middle fossa craniotomy from 1992 to 1998.

Main Outcome Measures Potential prognostic indicators, including tumor size and nerve of origin, preoperative pure-tone average, speech discrimination, distortion product otoacoustic emission testing, age, auditory brainstem response (ABR), and electronystagmography.

Results Postoperative hearing near preoperative levels was attained in 167 patients (50%), with an American Academy of Otolaryngology—Head and Neck Surgery Class A hearing result in 33% and a Class B result in 26%. Comparison of potential prognostic indicators between groups with hearing preserved and the group with no measurable hearing revealed significant differences in preoperative hearing, ABR, and tumor origin data. Better preoperative hearing, shorter intraaural wave V latency, shorter absolute wave V latency, and superior vestibular nerve origin were associated with higher rates of hearing preservation.

Conclusions Preoperative hearing status, ABR, and intraoperative tumor origin data were shown to be of value as prognostic indicators.

*House Ear Clinic and House Ear Institute, Los Angeles, California; †Private Practice, Dallas, Texas, formerly at House Ear Clinic; ‡Private Practice, Los Angeles, California; §Department of Otolaryngology, Columbia University, New York, New York, formerly at House Ear Clinic

Presented at the American Neurotology Society annual meeting, April 24–25, 1999, Palm Desert, California, U.S.A.

Address correspondence to Dr. Derald Brackmann, House Ear Institute, Clinical Studies Department, 2100 West 3rd Street, 5th Floor, Los Angeles, CA 90057, U.S.A.

© 2000 Lippincott Williams & Wilkins, Inc.