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Unilateral Acoustic Neuromas: Long-Term Hearing Results in Patients Managed with Fractionated Stereotactic Radiotherapy, Hearing Preservation Surgery, and Expectantly

Authors

  • Vincent Y. W. Lin MD,

    Corresponding author
    1. Department of Otolaryngology, University of Toronto, Sunnybrook, and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
    • Dr. Vincent Yu-Wen Lin, and Dr. Julian Nedzelski, Department of Otolaryngology, Sunnybrook & Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3MS, Canada.
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  • Craig Stewart MD,

    1. Department of Otolaryngology, University of Toronto, Sunnybrook, and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
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  • Julia Grebenyuk MD,

    1. Department of Otolaryngology, University of Toronto, Sunnybrook, and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
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  • May Tsao MD,

    1. Department of Otolaryngology, University of Toronto, Sunnybrook, and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
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  • David Rowed MD,

    1. Department of Otolaryngology, University of Toronto, Sunnybrook, and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
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  • Joseph Chen MD,

    1. Department of Otolaryngology, University of Toronto, Sunnybrook, and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
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  • Julian Nedzelski MD

    1. Department of Otolaryngology, University of Toronto, Sunnybrook, and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
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Abstract

Introduction: Hearing preservation is invariably a consideration when exploring treatment options for acoustic neuromas. We reviewed the long-term hearing results of patients who were treated using 1) hyperfractionated stereotactic radiotherapy (HSR), 2) hearing preservation tumor excision surgery (HPTES), and 3) expectantly (no treatment).

Methods and Materials: Single institution retrospective chart review of 42 patients managed with HSR (1993–2003), 113 patients in whom HPTES was carried out, and 86 patients who were untreated (1974–2003). Hearing levels were graded according to the Gardner-Robertson classification.

Results: The percent of patients managed with HSR initially who had serviceable hearing (class 1–2) was 68.8%. This fell to 6.7% in the follow-up interval. Of the group treated with HPTES, 100% had preoperative serviceable hearing. This dropped to 15.9% in the follow-up interval. The percent of patients managed expectantly who initially had serviceable hearing was 77.3%. This dropped to 33.3% during the follow-up interval. Mean follow-up periods were 4.0, 9.5, and 6.8 years in the HSR, HPTES, and expectant groups, respectively.

Conclusions: Hearing acuity statistically worsened over the long term (P < .01) in all three groups. There was a significant proportion of patients in whom hearing deteriorated from serviceable to nonserviceable hearing (P < .01) during the follow-up interval. The decline was most significant in the groups treated with HPTES and HSR compared with the group treated expectantly (P < .05). Hearing outcomes, in our experience, continue to be poor, but this is especially so in patients treated with HPTES or HSR.

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