Hearing preservation in the resection of vestibular schwannomas: patterns of hearing preservation and patient-assessed hearing function

Clinical article

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Object

No extant literature documents the analysis of patient perceptions of hearing as a corollary to objective audiometric measures in patients with vestibular schwannoma (VS), or acoustic neuroma. Therefore, using objective audiometric data and patient perceptions of hearing function as outlined on a questionnaire, the authors evaluated the hearing of patients who underwent VS resection.

Methods

This investigation involved a retrospective review of 176 patients who had undergone VS resections in which hearing preservation was a goal. Both pre- and postoperative audiometry, expressed as a speech discrimination score (SDS) and pure tone threshold average (PTA), were performed, and the results were analyzed. Intraoperative auditory brainstem responses were also recorded. Eighty-seven of the patients (49.4%) completed a postoperative questionnaire designed to assess hearing function in a variety of social and auditory situations. Multiple linear regression analyses were completed to compare available audiometric results with questionnaire responses for each patient.

Results

One hundred forty-two patients (80.7%) had PTA and SDS audiometric data pertaining to the surgically treated ear; 94 of these patients (66.2%) had measurable postoperative hearing, as defined by a PTA < 120 dB or SD > 0%. Eighty-seven patients (49.4%) completed the retrospective questionnaire, and 74 of them had complete audiometric data and thus were included in a comparative analysis. Questionnaire data showed major postoperative subjective hearing decrements, even among patients with the same pre- and postoperative objective audiometric hearing status. Moreover, the subscore reflecting hearing while exposed to background noise, or the “cocktail party effect,” characterized the most significant patient-perceived hearing deficit following VS resection.

Conclusions

The authors' analysis of a patient-perceived hearing questionnaire showed that hearing during exposure to background noise, or the cocktail party effect, represents a significant postoperative hearing deficit and that patient perception of this deficit has a strong relation with audiometric data. Furthermore, questionnaire responses revealed a significant disparity between subjective hearing function and standard audiometrics such that even with similar levels of audiometric data, subjective measures of hearing, especially the cocktail party effect, decreased postoperatively. The authors posit that the incorporation of patient-perceived hearing function evaluation along with standard audiometry is an illustrative means of identifying subjective hearing deficits after VS resection and may ultimately aid in specific and subsequent treatment for these patients.

Abbreviations used in this paper: AAO-HNS = American Academy of Otolaryngology–Head and Neck Surgery; PTA = pure tone threshold average; QOL = quality of life; SD = speech discrimination; SDS = SD score; VS = vestibular schwannoma.

Article Information

Address correspondence to: Douglas E. Anderson, M.D., Department of Neurological Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois 60153. email: dander1@lumc.edu.

Please include this information when citing this paper: published online December 17, 2010; DOI: 10.3171/2010.11.JNS091752.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Flowchart showing relevant patient numbers and data flow. n = number of patients.

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    Box plot demonstrating the average percent changes in composite questionnaire scores as a function of the magnitude of change in the AAO-HNS class. Negative average changes indicate a decrease in QOL. No instances of 3-fold positive class changes (for example, from Class D to Class A) were observed. Horizontal black bar = median; box = middle 2 quartiles; whiskers = total data range; open circles = outliers.

  • View in gallery

    Bar graph showing average changes in cocktail party effect questions (Statements 1, 6, 7, 11, 16, 19, and 24) as a function of performance in audiometrics. Negative decrements signify greater perceived hearing difficulty. N = no change; S = SDS change; P = PTA change; B = change in both SDS and PTA (p < 0.005).

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