Hearing Outcomes in Conservatively Managed Vestibular Schwannoma Patients With Serviceable Hearing

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 50dB HL and word recognition score 50%.Results:Four-hundred sixty-six patients (median age of 57 yr and median tumor diameter of 7.3mm) 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.