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Long-Term Hearing Preservation After Microsurgical Excision of Vestibular Schwannoma

Woodson, Erika Ann*; Dempewolf, Ryan Douglas*; Gubbels, Samuel Paul; Porter, Aaron Thomas; Oleson, Jacob Jay; Hansen, Marlan Rex*; Gantz, Bruce Jay*

doi: 10.1097/MAO.0b013e3181edb8b2
Tumors of the Ear and Cranial Base
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Objective: To examine long-term hearing outcomes after microsurgical excision of vestibular schwannoma (VS).

Study Design: Retrospective case review.

Setting: Tertiary referral center.

Patients: Forty-nine subjects at a single institution who had undergone microsurgical excision of a VS via middle cranial fossa (MCF) approach between 1994 and 2007 with immediate postoperative (PO) hearing preservation and for whom long-term audiograms were available.

Intervention: Diagnostic.

Main Outcome Measures: Word Recognition Score (WRS) is defined by speech discrimination scores (SDS) greater than 70% (grade I), 50% to 70% (grade II), less than 50% (grade III), and 0% (grade IV).

Results: For subjects with more than 2 years of follow-up, WRS I hearing was present PO in 42 of 49 patients and was preserved at the latest follow-up in 38 (90%) of 42 patients. No subjects fell beyond WRS II. WRS I hearing was maintained in 23 (88%) of 26 patients with more than 5 years of follow-up. Postoperative WRS I to II hearing was maintained in 28 (96%) of 29 patients with more than 5 years of follow-up. The patient who lost significant hearing in the ear operated on had sensorineural hearing loss that paralleled deterioration in her ear that was not operated on.

Conclusion: Most subjects maintain their initial PO SDS after microsurgical VS removal, and therefore, the initial PO WRS is predictive of long-term hearing. Postsurgical changes do not alter the natural rate or pattern of progressive bilateral sensorineural hearing loss in individual subjects.

*Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; †Department of Surgery-Otolaryngology Division, University of Wisconsin-Madison, Madison, Wisconsin; and ‡Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, U.S.A.

Address correspondence and reprint requests to Bruce Jay Gantz, M.D., Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr (21201 PFP), Iowa City, IA 52242-1078; E-mail: bruce-gantz@uiowa.edu

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