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Long-term prognosis of preserved useful hearing after surgery in patients with vestibular schwannoma: a study of 91 cases

  • Original Article - Tumor - Schwannoma
  • Published:
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Abstract

Background

In patients with a vestibular schwannoma, some studies have reported that useful hearing preserved initially after surgery deteriorates gradually in the long term. Studies with more patients are needed to clarify the maintenance rate of postoperative hearing function and to identify prognostic of hearing function.

Method

Ninety-one patients (mean age, 39.5 years; mean tumor size, 18.9 mm) with preserved useful hearing immediately after surgery were retrospectively analyzed. The useful hearing was defined as the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classes A and B. Hearing tests, including auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE), were evaluated preoperatively, immediately after surgery, and at outpatient follow-up.

Results

At the final follow-up (mean, 63.0 months), the useful hearing was maintained in 79 patients (87%), and the hearing class remained unchanged during the follow-up period in 40 patients (44%). Significant predictors of useful hearing maintenance were AAO-HNS class A immediately after surgery, improvement of ABR, and the absence of postoperative DPOAE deterioration. Postoperative DPOAE deterioration correlated with hearing class deterioration.

Conclusions

Despite hearing being preserved in vestibular schwannoma patients immediately after surgery, Thirteen percent lost their useful hearing during the long follow-up period, and hearing class worsened in 55% of the patients. This study, which analyzed one of the largest series of vestibular schwannoma patients, demonstrated that retrocochlear condition is a key factor for useful hearing maintenance. In patients with vestibular schwannoma who have preserved hearing function, regular postoperative monitoring of hearing function is as important as regular MRI.

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Abbreviations

AAO-HNS:

American Academy of Otolaryngology-Head and Neck Surgery

ABR:

Auditory brainstem responses

DPOAE:

Distortion product otoacoustic emissions

F/U:

Follow-up

HB:

House–Brackmann

iABR:

Improvement of ABR

IPO:

Immediately postoperative

N:

Normal detection

ND:

Complete nondetection

P:

Partial detection

PDD:

Postoperative DPOAE deterioration

PTA:

Pure tone average

SEP:

Sensory evoked potentials

SDS:

Speech discrimination score

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan

    Norio Ichimasu, Michihiro Kohno, Nobuyuki Nakajima, Ken Matsushima & Yujiro Tanaka

  2. Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan

    Michihiro Kohno & Masanori Yoshino

  3. Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan

    Kiyoaki Tsukahara & Taro Inagaki

  4. Department of Anesthesiology, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan

    Osamu Nagata

Authors
  1. Norio Ichimasu
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  2. Michihiro Kohno
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  3. Nobuyuki Nakajima
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  4. Ken Matsushima
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  5. Yujiro Tanaka
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  7. Taro Inagaki
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  8. Masanori Yoshino
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  9. Osamu Nagata
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Contributions

We would like to thank Dr. Hitoshi Izawa and Dr. Jiro Akimoto for their help and advice. The authors are indebted to Helena Akiko Popiel, Department of International Medical Communications of Tokyo Medical University, for her review of the English manuscript. And, we thank Mrs. Asa Otonari for her assistance in preparing this manuscript.

Corresponding author

Correspondence to Michihiro Kohno.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Tokyo Medical University and Tokyo Metropolitan Police Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ichimasu, N., Kohno, M., Nakajima, N. et al. Long-term prognosis of preserved useful hearing after surgery in patients with vestibular schwannoma: a study of 91 cases. Acta Neurochir 162, 2619–2628 (2020). https://doi.org/10.1007/s00701-020-04523-2

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  • DOI: https://doi.org/10.1007/s00701-020-04523-2

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