2025 Proffered Presentations
S273: HEARING PRESERVATION SURGERY FOR VESTIBULAR SCHWANNOMA: ANALYSIS OF MID- AND LONG-TERM HEARING OUTCOMES
Diego Cazzador; Antonio Daloiso; Giulia Tealdo; Valerio M Di Pasquale Fiasca; Davide Brotto; Stefano Concheri; Antonio Mazzoni; Elisabetta Zanoletti; Otorhinolaryngology Unit - University of Padova
Introduction: Vestibular schwannoma (VS) management is decided on patients- and tumor-related factors. When hearing is preserved at diagnosis, treatment options should also aim to maintain hearing function. In small VS, observation, radiotherapy, and hearing-preserving surgery (HPS) can initially offer hearing preservation, but long-term results in the literature are sparse. The aim of the study is to define the mid and long-term audiological results in patients with VS undergoing HPS and assess the stability of preserved hearing. A systematic literature review on the topic was conducted as well.
Material and Methods: Between 2011 and 2023, 47 patients with sporadic VS underwent HPS via retrosigmoid approach and retrolabyrinthine meatotomy. Twenty-one were included in the study (13 males [61.9%], mean age 49 years), according to the inclusion criteria: postoperative hearing preservation, and audiological follow-up ≥36 months (mid-term). PTA-SDT-SRT-SDS were determined, and hearing classified according to AAO-HNS and Tokyo classifications. A subgroup of 12 patients with ≥60 months follow-up was separately evaluated. Additionally, the literature was sought for studies on long-term audiological follow-up after VS resection with hearing preservation intent. The pooled prevalence of maintaining long-term serviceable hearing was calculated.
Results: Sixteen patients (76.2%) had at 36 months AAO-HNS class A/B. Compared with the immediate postoperative results, 20 patients (95.2%) improved or maintained their hearing class. At 60-month follow-up, 66.7% patients retained class A/B. Ten patients (83.3%) improved or maintained their class. The audiometric values recorded at 2, 36 months and at the last follow-up showed no significant changes over time (Friedman test). The estimated 5-year probability of maintaining serviceable hearing was 91.7% (95%CI=53.9%-98.8%). According to the literature, the prevalence of maintaining long-term serviceable hearing after HPS presented a pooled estimate of 74.5% (95% CI: 63.5%-84.1%).
Conclusions: HPS for small VS demonstrated stable audiological results in the mid and long-term follow-up. Results were comparable with the current literature on the topic. HPS can be considered a valid option aiming to cure the disease and preserve patients’ hearing over the mid- and long-term follow-up.