title: Conservative management of vestibular schwannoma: Predictors of growth and hearing.
abstract: OBJECTIVE
  To describe the clinical outcomes of patients undergoing serial observation for vestibular schwannoma (VS) and identify factors that may predict tumor growth or hearing loss.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  A retrospective review was conducted of patients seen at a tertiary care medical center between 2002 and 2013 with an International Classification of Diseases-9 diagnosis code of 225.1. Patients electing observation as initial management, with at least two documented imaging results, were included. Exclusion criteria comprised bilateral VS, diagnosis of neurofibromatosis type 2, and neoplasms other than VS. Decline in serviceable hearing, tumor growth, and changes in management strategy were recorded. Survival analysis to assess median time to outcomes and multiple logistic regression analyses were performed.
  
  
  RESULTS
  A total of 94 patients met inclusion criteria. While undergoing observation, 22.3% of patients underwent a change in management strategy to microsurgical excision or stereotactic radiotherapy. For patients with initial serviceable hearing, 24.3% observed a decline to a nonserviceable level. No significant clinical factors were identified to predict changes in hearing. Survival analysis revealed that an estimated 69.1% of patients electing observation as initial management continued to do so at 5 years. Imbalance or disequilibrium at presentation was found to be associated with an increased adjusted odds ratio (OR) (OR 2.96; 95% confidence interval, 1.03-8.50; P = 0.04) for tumor growth.
  
  
  CONCLUSIONS
  Serial observation of VS is a viable treatment strategy for selected patients, with two-thirds of patients electing to continue this management option after 5 years. Disequilibrium as a presenting symptom may be associated with subsequent tumor growth.
  
  
  METHODS
  4.
authors: Department of Otolaryngology, New York University School of Medicine, New York, New York.
authors: Daniel
authors: http://orcid.org/0000-0003-1577-575X
authors: D
authors: Jethanamest
authors: Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
authors: Andrew M
authors: AM
authors: Rivera
authors: Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
authors: Hongzhao
authors: H
authors: Ji
authors: Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
authors: Venkatakarthikeyan
authors: V
authors: Chokkalingam
authors: Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
authors: Fred F
authors: FF
authors: Telischi
authors: Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
authors: Simon I
authors: SI
authors: Angeli
mesh_terms: D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing / Q000502:physiology*; D034381:Hearing Loss / Q000209:etiology* / Q000503:physiopathology; D006320:Hearing Tests; D006801:Humans; D008297:Male; D009464:Neuroma, Acoustic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D057832:Watchful Waiting / Q000379:methods*
keywords: Vestibular schwannoma; acoustic neuroma; conservative management; cranial nerve; disequilibrium; hearing loss; imbalance; observation; tumor