Tumor growth and audiometric change in vestibular schwannomas managed conservatively

Objective: To prospectively define the correlation between changes in tumor volume and audiometric function in vestibular schwannomas managed conserva tively. Study Design: Prospective longitudinal study. Methods: Twenty-one p atients (age range, 15-84 y; mean age, 63.3 y) with newly diagnosed vestibu lar schwannomas were enrolled between 1994 and 1999 in a protocol at The Oh io State University Hospital (Columbus, OH) to evaluate the correlation bet ween tumor volume and audiometric change during a period of observation. Pa tients were evaluated yearly by clinical examination, a standardized intern al auditory canal magnetic resonance imaging scan with gadolinium contrast for volumetric analysis, and audiometric function testing. Demographic data , historical features, neurofibromatosis type 2 (NF2) status, initial testi ng results, and serial testing results were recorded. Results: An increase in tumor volume occurred in 14 of the 21 patients (66%), The pattern of vol umetric change was found to be extremely variable. Multiple regression anal ysis revealed significant correlations of changes in tumor volume with chan ges in pure-tone average and speech discrimination score (P < .0001 and P = ,0021, respectively). Change in tumor volume had greater effect on pure-to ne average and speech discrimination score in patients initially with class D audiometric function when compared with these initially in class A (P = .0083 and P = .0245, respectively). The presence of NF2 had an independent protective effect against deterioration of the pure-tone average when compa red with patients without NF2 (P = .0125), Conclusions: This study demonstr ated a significant correlation between a change in volume and auditory dete rioration in vestibular schwannomas being managed with a trial of observati on. A given change in tumor volume appeared to have a greater effect on pur e-tone average and speech discrimination score as initial auditory classifi cation declined.