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Hearing Outcomes in Conservatively Managed Vestibular Schwannoma Patients With Serviceable Hearing

Hunter, Jacob B.*; Dowling, Eric M.; Lohse, Christine M.; O’Connell, Brendan P.§; Tombers, Nicole M.; Lees, Katherine A.; Thompson, Reid S.||; Haynes, David S.||,¶; Carlson, Matthew L.

doi: 10.1097/MAO.0000000000001914
TUMORS OF THE EAR AND CRANIAL BASE
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Objective: To characterize the risk of progression to nonserviceable hearing in patients with sporadic vestibular schwannomas (VS) who elect initial observation.

Study Design: Retrospective case series.

Setting: Two tertiary care centers.

Patients: VS patients with serviceable hearing who underwent at least two audiograms and two MRI studies before intervention or loss to follow-up.

Main outcome measure(s): Serviceable hearing, defined as the pure tone average ≤ 50 dB HL and word recognition score ≥ 50%.

Results: Four-hundred sixty-six patients (median age of 57 yr and median tumor diameter of 7.3 mm) had serviceable hearing at presentation and were followed for a median of 2.3 years (IQR 1.0 – 4.0). Kaplan–Meier estimated rates of maintaining serviceable hearing (95% CI; number still at risk) at 1, 3, 5, 7, and 10 years following diagnosis were 94% (91–96; 357), 77% (73–82; 172), 66% (60–73; 81), 56% (49–65; 31), and 44% (33–59; 10), respectively. Each 10-dB increase in pure-tone averages at diagnosis was associated with a 2-fold increased likelihood of developing nonserviceable hearing (hazard ratio 2.07; p < 0.001). Each 10% decrease in word recognition score was associated with a 1.5-fold increased likelihood of developing nonserviceable hearing (hazard ratio 1.48; p < 0.001).

Conclusions: Among patients with sporadic VS, good baseline word recognition score and low pure-tone average are jointly associated with maintenance of serviceable hearing. These data may be used to guide patient counseling and optimize management.

*Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas

Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic School of Medicine

Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota

§Department of Otolaryngology, University of North Carolina, Chapel Hill, North Carolina

||Department of Neurosurgery

Department of Otolaryngology—Head and Neck Surgery, The Otology Group of Vanderbilt University, Vanderbilt University Medical Center, Nashville, Tennessee

Address correspondence and reprint requests to Jacob B. Hunter, M.D., Department of Otolaryngology—Head and Neck Surgery, 5323 Harry Hines Blvd., Dallas, TX 75390; E-mail: jacob.b.hunter@gmail.com

Institutional Review Board Approval(s): #151481 and 15-008224.

D.S.H. is a consultant for Stryker and Synthes.

The authors disclose no conflicts of interest.

Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company