Acoustic neuroma observation associated with an increase in symptomatic tinnitus: results of the 2007–2008 Acoustic Neuroma Association survey

Clinical article

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Object

Tinnitus is a known presenting symptom of acoustic neuromas, but little is known about the impact of observation or treatment on tinnitus. Most patients experience improvement with treatment, while others may worsen. Therefore, this study was designed to assess the overall impact of observation and treatment on tinnitus outcome in patients with acoustic tumors.

Methods

Data from the 2007–2008 Acoustic Neuroma Association survey were used. Tinnitus severity was graded both at presentation and at last follow-up for all patients questioned. This data set was analyzed using the Student t-test and a linear regression model adjusted for possible confounders.

Results

Overall there were more patients receiving intervention (n = 1138) for their acoustic neuromas than observation (n = 289). Presenting tumor size positively correlated with tinnitus severity score. Regardless of treatment (microsurgery or stereotactic radiosurgery), tinnitus improved at last follow-up and worsened in those who were observed (p = 0.02). When comparing microsurgical options, retrosigmoid and translabyrinthine resection improved tinnitus symptoms (both p < 0.01). Stereotactic radiosurgery had a treatment effect similar to microsurgery.

Conclusions

Presenting tinnitus severity correlates strongly with tumor size. Furthermore, regardless of treatment, there appears to be an overall reduction in tinnitus severity for all forms of microsurgery and stereotactic radiosurgery. Importantly, observation leads to a worsening in symptomatic tinnitus and therefore should be weighed in the treatment recommendation.

Abbreviation used in this paper:ANA = Acoustic Neuroma Association.

Article Information

Address correspondence to: Siviero Agazzi, M.D., M.B.A., Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606. email: sagazzi@health.usf.edu.

Please include this information when citing this paper: published online June 21, 2013; DOI: 10.3171/2013.5.JNS122301.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Graphs showing treatment impact on tinnitus severity. Left: Absolute change in tinnitus severity score (mean ± SEM) of treated patients (n = 1138) compared with those electing for observation (n = 289). There was a significant improvement in tinnitus after treatment, whereas observation lead to worsened tinnitus at follow-up (p < 0.0001, Student t-test). Right: Absolute change in tinnitus severity score (mean ± SEM) comparing the translabyrinthine (TL, n = 422), retrosigmoid (RS, n = 249), middle fossa (MF, n = 122), and stereotactic radiosurgery (SRS, n = 221) treatment categories. There were no significant differences between treatment groups (p = 0.60, ANOVA).

  • View in gallery

    Graphs showing the impact of tumor size at presentation on tinnitus severity. Left: At presentation, as tumor size increased, the severity of tinnitus also increased (p = 0.01). Right: Mean tumor size at presentation (with 95% CIs) of various treatment cohorts. Tumor size at presentation was significantly smaller for the observation group (p < 0.001, Student t-test). Furthermore, tumors treated using the translabyrinthine approach were significantly larger than those in all other treatment groups at presentation, followed by those in the retrosigmoid group, and lastly the middle fossa group.

  • View in gallery

    Graphs showing assessment of presentation year and influence on tinnitus. Left: Tumor size at presentation compared with year of presentation. There was no change in mean tumor size at presentation throughout the study. Right: After dividing patients into epochs of presentation there was a significant reduction found in overall improvement of tinnitus in earlier epochs. There were 54 patients between 1966 and 1988, 310 between 1989 and 1998, and 1063 after 1998. Values on the y axis represent the absolute change in the preoperative tinnitus severity score compared with the presently reported score.

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