HEARING RESULTS IN SURGERY FOR PRIMARY PETROUS APEX LESIONS

Hearing preservation is a frequently mentioned phrase in the growing f ield of skull base surgery. Many authors have attempted to identify pr ognostic factors for successful hearing preservation, and many have su ggested alternative procedures for preserving serviceable hearing. Few have mentioned hearing improvement with skull base surgical procedure s. In this article we present the hearing results of 25 surgical proce dures for primary petrous apex lesions. These include 13 cholesterol g ranulomas, 5 cholesteatomas, 4 mucoceles, and 3 eosinophilic granuloma s. Surgical approaches included 14 transmastoid/infralabyrinthine, 6 t ransphenoid, 3 suboccipital, and 2 transmastoid/translabyrinthine. Hea ring was maintained in 14 patients (56%), improved in 9 patients (36%) , and worse in 1 patient with nonserviceable hearing before surgery (4 %); 1 patient had profound hearing loss before surgery (4%). Results o f this review should have significant implications on the choice of su rgical approach for petrous apex lesions. Additionally, the standard m ethod of determining salvageable hearing for most skull base procedure s may not apply for this specific group of lesions. Implications for f uture treatment plans will be discussed in detail.