Is it worthwhile to attempt hearing preservation in larger acoustic neuromas?

Otol Neurotol. 2003 May;24(3):460-4. doi: 10.1097/00129492-200305000-00017.


Objective: To determine the hearing outcome in patients undergoing surgery via the retrosigmoid approach for acoustic neuromas with a substantial component in the cerebellopontine angle.

Study design: Retrospective case review.

Setting: Tertiary referral center.

Patients: The medical records of all patients undergoing acoustic neuroma removal via the retrosigmoid approach at a tertiary referral center were retrospectively reviewed. Sixty-four patients with both cerebellopontine angle component >or=15 mm and preoperative audiometry of class A or B (American Academy of Otolaryngology-Head and Neck Surgery) were identified.

Main outcome measures: Postoperative average pure tone threshold and word recognition scores, categorized according to the classification of the American Academy of Otolaryngology-Head and Neck Surgery, were used to assess hearing outcome.

Results: Overall, only 6.3% (4 of 63) retained good hearing (class A or B) postoperatively. Hearing preservation rate in the smallest (15- to 19-mm) group was 17.6% (3 of 17), which was better than that for the larger groups. No successful hearing preservation was achieved in tumors with >or=25 mm cerebellopontine angle component (0 of 23).

Conclusions: Surgeon and patient alike would always choose a hearing preservation technique if there was no potential for increased morbidity in making the attempt. When compared with the non-hearing preservation translabyrinthine approach, the retrosigmoid approach had a higher incidence of persistent headache. In addition, efforts to conserve the auditory nerve prolong operating time, increase the incidence of postoperative vestibular dysfunction, and carry a slightly higher risk of tumor recurrence. Nevertheless, even though the probability of success is disappointingly small, when excellent hearing is present we favor offering the option of a hearing conservation attempt when the patient has been well informed of the pros and cons of the endeavor. Factors weighing against undertaking this effort include larger cerebellopontine angle component (>or=25 mm), deep involvement of the fundus, wide erosion of the porus, and marginal residual hearing.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Audiometry, Pure-Tone
  • Cerebellopontine Angle / pathology
  • Hearing Disorders / diagnosis*
  • Hearing Disorders / etiology
  • Humans
  • Magnetic Resonance Imaging
  • Middle Aged
  • Neoplasm Invasiveness / pathology
  • Neuroma, Acoustic / complications*
  • Neuroma, Acoustic / pathology
  • Neuroma, Acoustic / surgery*
  • Otologic Surgical Procedures / methods*
  • Postoperative Care
  • Preoperative Care
  • Retrospective Studies
  • Severity of Illness Index
  • Speech Perception / physiology