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J Neurol Surg B Skull Base 2012; 73(04): 273-280
DOI: 10.1055/s-0032-1312710
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Determining Benchmarks in Hearing Preservation Surgery for Vestibular Schwannoma

Michael B. Gluth
1   Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
John D. Day
2   Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
John L. Dornhoffer
1   Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
› Author Affiliations
Further Information

Publication History

01 August 2011

12 December 2011

Publication Date:
17 May 2012 (online)

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Abstract

Objectives The objectives of this study were to determine minimal benchmarks of success in vestibular schwannoma hearing preservation surgery, wherein the likelihood of having preserved hearing in a single patient is at least as likely as having created a poor facial nerve outcome for a single patient.

Design This is a statistical analysis of published literature.

Setting Academic Tertiary Medical Center.

Main Outcome Measures Based on published natural history data, the number needed to treat (NNT) equation was used to calculate the minimally acceptable hearing preservation rates within various hearing classification schemes.

Results Given good facial nerve outcome rates of 85, 90, and 95%, the corresponding hearing preservation rates at 4.7 years that are likely to preserve classes A and B hearing (American Academy of Otolaryngology-Head and Neck Surgery classification) in a single patient as to cause a poor facial nerve outcome are 70, 65, and 60%, respectively. If surgery is limited exclusively to intracanalicular tumors, these rates drop to 62, 57, and 52%, respectively. If the word recognition scoring classification is used, required hearing preservation rates are higher.

Conclusion It is possible to use the NNT equation alongside projected facial nerve outcomes to estimate benchmarks of minimally acceptable hearing preservation rates.

Keywords

vestibular schwannoma - acoustic neuroma - hearing preservation - number needed to treat
 

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