title: Unilateral acoustic neuromas: long-term hearing results in patients managed with fractionated stereotactic radiotherapy, hearing preservation surgery, and expectantly.
abstract: BACKGROUND
  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
  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.
authors.affiliation: Department of Otolaryngology, University of Toronto, Sunnybrook, Ontario M4N 3MS, Canada. vlin@sympatico.ca
authors.forename: Vincent Y W
authors.initials: VY
authors.lastname: Lin
authors.forename: Craig
authors.initials: C
authors.lastname: Stewart
authors.forename: Julia
authors.initials: J
authors.lastname: Grebenyuk
authors.forename: May
authors.initials: M
authors.lastname: Tsao
authors.forename: David
authors.initials: D
authors.lastname: Rowed
authors.forename: Joseph
authors.initials: J
authors.lastname: Chen
authors.forename: Julian
authors.initials: J
authors.lastname: Nedzelski
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D013069:Speech Reception Threshold Test; D016896:Treatment Outcome