Audiological Outcomes, Tinnitus, Quality of Life, and Tumor Size After Stereotactic Radiosurgery for Vestibular Schwannoma: A Prospective Study

Objective: Vestibular schwannoma (VS) is a benign tumor that is often associated with hearing loss and tinnitus.Stereotactic radiosurgery (SRS) has been widely used to treat these tumors.However, hearing preservation following the procedure remains a challenge, particularly regarding the influence of the intracochlear radiation dose.The study's objective was to evaluate the effects of SRS on hearing function, perceived hearing handicap, tinnitus, quality of life, and tumor control in patients with VS, as well as to investigate the association between intracochlear radiation dose and audiological outcomes.Methods: This prospective study included 30 patients who underwent SRS between 2017 and 2020.Puretone and speech audiometry, the Hearing Handicap Inventory for Adults (HHIA), the Tinnitus Handicap Inventory (THI), and quality-of-life assessments were performed before treatment and after a mean followup of 21 months (range, 3-48 months).Patients were stratified according to the intracochlear radiation dose received (≤5 Gy, >5 and <6 Gy, and ≥6 Gy).Statistical analyses included the Wilcoxon signed-rank test for continuous variables and two-sided exact McNemar tests for categorical outcomes, with Holm adjustment for multiple comparisons.Results: Audiometric classifications showed a significant redistribution after SRS, with fewer patients in category B (p=0.031) and more in category C (p=0.044).No significant changes were observed in HHIA or World Health Organization Quality of Life Instrument -Short Form (WHOQOL-BREF) categories.THI showed an increase in the proportion of patients classified as having mild tinnitus and a reduction in those classified as having severe tinnitus (p=0.020 and p=0.031, respectively).Significant tumor size reduction was observed in patients with ≥24 months of follow-up (p=0.02).No significant association was detected between intracochlear radiation dose and the audiological outcomes evaluated.Conclusion: Tumor size reduction was observed after ≥24 months of follow-up.Audiometric and tinnitus classifications showed significant changes in the overall sample, whereas subjective hearing handicap and quality of life did not.No significant association was detected between intracochlear radiation dose and the audiological outcomes evaluated.These findings should be interpreted cautiously given the small sample size.