Long-Term Hearing Preservation in Vestibular Schwannoma

Objective: The aim of the present study was to evaluate the long-term hearing during "wait and scan" management of vestibular schwannomas. Subjects: During a 33-year period, from 1976 to 2008, 1,144 patients with vestibular schwannoma were allocated to observation by the wait and scan policy, with annual magnetic resonance imaging and audiologic examination. Two complete pure-tone and speech discrimination audiograms were available for 932 patients. In 900 patients (97%), the wait and scan period was at least 1 year. In 377 patients (40%), the observation time was at least 5 years, and in 102 patients (11%), at least 10 years. Results: At diagnosis, 491 patients (53%) presented with good hearing, that is, speech discrimination better than 70%. After a mean of 4.7 years of observation, 59% of these patients spontaneously preserved good hearing. Of patients with 100% speech discrimination at diagnosis, 69% maintained good hearing after more than 10 years of observation. Of patients with only a small discrimination loss at diagnosis, 38% maintained good hearing. Conclusion: Most vestibular schwannoma patients with 100% speech discrimination at diagnosis maintain good hearing even after many years of observation.