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Beyond the ABCs: Hearing Loss and Quality of Life in Vestibular Schwannoma

      Abstract

      Objective

      To assess the impact of differential hearing loss on QOL in sporadic unilateral vestibular schwannoma.

      Patients and Methods

      Cross-sectional observational multicenter study including 422 patients with vestibular schwannoma and formal audiometry within 1 year of survey administration, analyzed using multivariable regression.

      Results

      Among 422 patients included, the median age was 57 (range, 18-81) years; 223 (53%) were women. Among 390 patients with complete audiometric data, American Academy of Otolaryngology-Head and Neck Surgery class was A in 134 (34%), B in 69 (18%), C in 26 (7%), and D in 161 (41%). A total of 335 of 390 (86%) reported subjective ipsilateral hearing loss (median severity, 6/10 [1 = normal, 10 = deaf]), 166 (43%) reported ipsilateral inability to use the telephone, 155 (37%) reported that hearing loss had affected personal relationships, and 213 (51%) reported difficulty with conversations. After adjusting for age and sex, the odds ratio (OR) for hearing loss adversely affecting relationships was 4.4 for class B hearing vs class A (95% CI, 2.1-9.4; P<.0001). The OR for difficulty with conversations was 2.7 for class B vs class A (95% CI, 1.4-5.3; P=.003). The OR for lost ipsilateral telephone use was 6.3 for class B vs class A (95% CI, 3.2-13.0; P<.0001). Differences between class B and class C were not significant. WRS outperformed PTA as a predictor of hearing-related QOL. The optimal threshold for predicting a significant adverse impact on QOL was WRS less than 72% to 76%.

      Conclusion

      Hearing loss adversely affects QOL after only modest audiometric disability. The WRS alone appears to be a much more reliable predictor of hearing-related QOL than PTA or American Academy of Otolaryngology-Head and Neck Surgery class.

      Abbreviations and Acronyms:

      AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery), AUC (area under the curve), HC (hearing class), OR (odds ratio), PANQOL (Penn Acoustic Neuroma Quality-of-Life Scale), PTA (pure tone average), QOL (quality of life), ROC (receiver operating characteristic), VS (vestibular schwannoma), WRS (word recognition score)
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