title: Late failure rate of hearing preservation after middle fossa approach for resection of vestibular schwannoma.
abstract: OBJECTIVE
  To explore the long-term hearing results after a middle fossa approach for resection of vestibular schwannoma.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  All patients undergoing a middle fossa approach for resection of vestibular schwannoma at a single institution with intent to preserve hearing between December 1989 and December 2009 were included in the study population.
  
  
  METHODS
  Standard middle fossa approach for resection of vestibular schwannoma, magnetic resonance imaging (MRI), and audiogram.
  
  
  METHODS
  Recurrence of tumor as evaluated by MRI and hearing results as measured by serial audiograms.
  
  
  RESULTS
  Seventy-eight patients were identified who met study criteria. Fifty-one (65%) of the 78 patients had usable hearing (American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS] class A or B) postoperatively. Forty-four patients with successful hearing preservation had follow-up beyond their initial postoperative visit. Five (11%) of the 44 patients showed late degradation to nonserviceable hearing (AAO-HNS class C or D) over a mean follow-up of 4.0 years. Kaplan-Meier estimate of preservation of class A or B hearing at 10 years was 72%. Of the five patients with late degradation in hearing, 2 were found to have recurrences of their original tumor on MRI. There were 5 confirmed recurrences in the total study population.
  
  
  CONCLUSIONS
  Late degradation of hearing was an infrequent occurrence after initially successful hearing preservation. When hearing degradation did occur, there seemed to be a correlation with tumor recurrence.
authors.affiliation: Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota 55455-0392, USA. hilt0054@umn.edu
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Hilton
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Haines
authors.forename: Ankit
authors.initials: A
authors.lastname: Agrawal
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Levine
mesh_terms: D016009:Chi-Square Distribution; D035301:Cranial Fossa, Middle / Q000601:surgery*; D034381:Hearing Loss / Q000209:etiology*; D006801:Humans; D009464:Neuroma, Acoustic / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects*; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome