What Contributes to Long-Term Quality of Life in Vestibular Schwannoma?
Background: The objective of the current study is to investigate the factors that determine long-term QoL in vestibular schwannoma (VS). Methods: All patients with VS managed between 1998 and 2008 were surveyed using a composite questionnaire composed of eight validated instruments: the Facial and Headache Disability Indices, the Tinnitus, Dizziness and Hearing Handicap Inventories, the HADS scale, and the SF-36 and PANQOL questionnaires. Using stepwise regression we compared the impact of each symptom-specific instrument and clinical parameter upon the PANQOL total and SF-36 physical and mental summary scores. The magnitude of association between each independent variable and the main outcome was compared. Results: A total of 538 completed surveys were analyzed. The response rate was 79% and the duration between treatment and survey was 7.7 years. All symptom-specific questionnaires were significantly associated with the PANQOL and SF-36. Overall, dizziness was the strongest predictor of impaired long-term QoL, followed by hearing handicap, depression, facial nerve dysfunction, anxiety, tinnitus, and headache. The weakest predictors were facial nerve function as evaluated by the physician and AAO-HNS hearing class. Conclusion: Patient-reported symptoms predict impaired QoL to a stronger degree than objective measures in VS. Almost 8 years after initial treatment, dizziness was the symptom most closely associated with poor QoL.