Preservation of hearing after surgery for vestibular schwannoma (clinical case with a literature review)

Objective. Maintaining hearing after surgery to remove vestibular schwannoma remains a difficult surgical task. In some patients with preserved inner ear function, hearing improvement is achievable. Since it is currently impossible to determine which patients will have such a result, forecasts should be based on previously published reports. In our clinical case, we describe a patient whose hearing improved from a minor level to a useful one after surgery to remove a vestibular schwannoma. Methods. The operation was performed by suboccipital retrosigmoid access. The patient underwent a basic audiovisual protocol before and after surgery: audiometry of pure tone and speech, otoacoustic emission, auditory reactions of the brain stem, electronystagmography, as well as a detailed questionnaire. The usefulness of hearing was assessed using international recommendations supplemented by a frequency of 4 kHz. Results. Hearing was preserved and even improved from a useless level to a useful one. Based on the available literature, the most informative factors predicting such a result seem to be: sudden sensorineural hearing loss before surgery, pronounced otoacoustic emission and damage to the upper vestibular nerve. Conclusion. There is a limited amount of research on this topic, and it is still impossible to regularly improve hearing in properly selected patients. In addition, the importance of postoperative hearing quality compared to other symptoms and complications remains controversial