Comparing Hearing Outcomes in Irradiated and Conservatively Managed Vestibular Schwannoma

Abstract

Objective: Compare hearing outcome for vestibular schwannoma patients following stereotactic radiosurgery (SRS) or conservative management. Study Design: Retrospective review. Setting: University Hospital. Patients: Patients with small-or medium-sized sporadic vestibular schwannoma (intracanalicular or with CPA component <2 cm) who were managed conservatively or underwent SRS with available clinical, radiological, and audiometric data from the time of presentation (or just before radiotherapy for the SRS group) and most recent follow-up; with the two sets of data to be compared being at least 3 years apart (minimum follow-up period). Interventions: SRS or observation. Main Outcome Measure: Pure-tone averages, speech discrimination scores, and corresponding hearing classifications. Results: Two hundred forty-seven patients met our inclusion criteria; 140 were managed conservatively with a mean follow-up period of 5.9 AE 1.6 years and 107 underwent SRS with a mean follow-up period of 7.1 AE 1.9 years. There was significant deterioration of hearing measures for both groups; with the SRS group displaying consistently worse measures. SRS patients showed worse mean pure-tone averages and speech discrimination scores decline rates by 2.72 dB/yr and 2.98 %/yr, respectively, when compared with conservatively managed patients. Stratifying patients according to Tokyo's hearing classification revealed that 68.75% of conservatively managed patients who had baseline serviceable hearing preserved their hearing throughout the studied period compared with only 15.38% of the SRS patients. Conclusion: Based on our data we conclude that patients with small-and medium-sized tumors will have a better hearing outcome if managed via an initial conservative approach with radiotherapy reserved for those demonstrating disease progression.

Management of Vestibular Schwannoma with Normal Hearing

“…Agreeing with our results of superiority of W&S for this subset of patients, a very recent study [Ismail et al, 2022] comparing hearing outcomes of W&S and SRS concluded that patients with small-and medium-sized tumors will have a better hearing outcome if managed via an initial conservative approach with radiotherapy reserved for those demonstrating disease progression.…”

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review

“…Comparative studies on the three viable management options for small VS, namely observation, radiosurgery and microsurgery, have shown similar results in terms of tumor control and FN function preservation. As far as hearing function is concerned, while it is generally agreed upon that short-term hearing preservation in small VS is better in patients undergoing a conservative management than in patients subjected to active treatment, whether it is surgery or stereotactic radiotherapy [ 25 , 26 ], data on long- term hearing preservation are more debatable, with some studies showing that hearing function decline is faster in the observation group after the first 2 years of follow up, while it predictably remains stable over time after surgery, as measured at 10 and 15 years [ 26 ].…”

Hearing Outcomes from Gamma Knife Treatment for Intracanalicular Vestibular Schwannomas with Good Initial Hearing

“…Vestibular schwannomas (VS) are benign tumors growing from the Schwann cells of the vestibular nerve, accounting for 6 to 8% of all intracranial tumors [ 1 ]. Incidence rates were reported to have increased over the years due to the enhancement of clinical awareness and imaging standards, and more intracanalicular VS have been detected.…”

“…These patients usually present with unilateral hearing loss or other otological symptoms (unilateral tinnitus, vertigo) while neurological symptoms tend to manifest in cases with larger tumors [ 1 ].…”