title: Working disability in Norwegian patients with vestibular schwannoma: vertigo predicts future dependence.
abstract: OBJECTIVE
  We examined whether reduced hearing, tinnitus, dizziness, and unsteadiness affected the patients' ability to maintain work within a time frame of 2-10 years after diagnosis.
  
  
  METHODS
  A total of 434 consecutive patients were followed at regular intervals. Data on symptoms were scored prospectively and dichotomized by visual analog scales for tinnitus and vertigo. Study design is retrospective. Hearing acuity was scored according to the Gardner-Robertson scale, and unsteadiness was measured on a balance platform. Patients were asked about working status, and scored as receiving governmental compensation for disability.
  
  
  RESULTS
  Two hundred six patients were eligible for study. Of these, one died and nine were lost to follow-up. Ninety-seven patients received conservative management, 49 patients recieved gamma knife radiosurgery, and 50 patients were treated by microsurgery. Mean follow-up time was 58.7 months (range, 20-132 months). There was a significant increase in the number of individuals receiving compensation during the study period (P < 0.0001). At baseline, the proportion of pension receivers was within same range as that of the age- and sex-matched Norwegian population (5.61% vs. 6.91%; case-control odds ratio, 0.82; 95% confidence interval 0.45-1.49; P = 0.51, not significant). At the final time point, the increase in the number of receivers deviated significantly from the reference population (case-control odds ratio, 3.80; 95% confidence interval 2.71-5.33; P ≤ 0.001). Examining symptoms at first presentation as predictors of future dependence revealed that vertigo and higher mean age were associated with a higher risk (P < 0.001 and P = 0.015, respectively). No other symptoms were predictive of dependence.
  
  
  CONCLUSIONS
  In a prospectively followed cohort of Norwegian patients with vestibular schwannoma, vestibular complaints were significant predictors for becoming dependant of disability pension.
authors.affiliation: Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway. Electronic address: cathrine.nansdal.breivik@gmail.com.
authors.forename: Cathrine Nansdal
authors.initials: CN
authors.lastname: Breivik
authors.forename: Roy Miodini
authors.initials: RM
authors.lastname: Nilsen
authors.forename: Erling
authors.initials: E
authors.lastname: Myrseth
authors.forename: Monica Katrine
authors.initials: MK
authors.lastname: Finnkirk
authors.forename: Morten
authors.initials: M
authors.lastname: Lund-Johansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D016001:Confidence Intervals; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009460:Neurologic Examination; D009464:Neuroma, Acoustic / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D019635:Neurosurgical Procedures; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D004856:Postural Balance; D011446:Prospective Studies; D016634:Radiosurgery; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014717:Vertigo / Q000209:etiology* / Q000503:physiopathology*; D055815:Young Adult
keywords: Acoustic neurinoma; CI; Confidence interval; Disability pension; GKRS; Gamma knife radiosurgery; OR; Odds ratio; QoL; Quality of life; VAS; VS; Vestibular schwannoma; Visual analog scale