Preoperative audiovestibular handicap in patients with vestibular schwannoma

Objectives: To evaluate preoperative hearing, dizziness, and tinnitus handicap in patients with unilateral vestibular schwannoma (VS). Design: Prospective administration of the Hearing Handicap Inventory (HHI), Dizziness Handicap Inventory (DHI), and Tinnitus Handicap Inventory (THI), prior to surgical intervention. Setting: A tertiary referral neuro-otology clinic. Participants: A total of 145 consecutive patients who were admitted for excision of their vestibular schwannomas between May 1998 and July 2002. Main Outcome Measures: HHI, THI, and DHI scores. Results: HHI, THI, and DHI scores were all found to be significantly correlated. There was no significant association between tumor size and any of the questionnaire scores. When data were categorized to give a measure of handicap severity, 68% had mild to significant hearing handicap, 30% had mild to severe tinnitus handicap, and 75% had mild to severe dizziness handicap. Eighty-eight percent of patients had some handicap in at least one domain, and 23% had some handicap in all three domains. Seven percent of patients had severe or significant handicap in all three domains. Conclusions: A considerable proportion of patients with unilateral VS have hearing, tinnitus, and dizziness handicap. These patients should optimally be offered appropriate rehabilitation, something that is especially important as conservative management by "watch, wait, and rescan" becomes more common.