Sense and nonsense of hearing after vestibular schwannoma surgery

Hearing preservation (HP) remains a challenge in vestibular schwannoma treatment. The literature and the authors' experience are reviewed. Classification of hearing is essential. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification is a major improvement. From 12 surgical series, only 16% of patients were actual candidates for HP. The average HP rate in patients with small tumors and class A or B hearing was 42% (808 attempted cases). When all tumor sizes and hearing levels were considered, the HP rate was 38% (2751 attempted cases). Delayed hearing loss was found in 19% after a mean follow-up period of 4.6 years. The AAO-HNS classification lacks a definition of time interval for postoperative audiometry. Moreover, the pure tone average (PTA) in the literature is not calculated in a uniform way. We conclude that the probability of lasting HP is not more than 0.35. Audiometry at I year post-treatment should be included in HP reports. A uniform way of calculating PTA is recommended.