Audiovestibular Handicap and Quality of Life in PatientsWith Vestibular Schwannoma and Excellent Hearing

BACKGROUND: Studies examining patient-reported outcomes in subjects with vestibular schwannoma (VS) and excellent hearing are lacking. OBJECTIVE: To assess patient-reported audiovestibular handicap and overall quality of life (QoL) in VS patients with class A hearing in both ears. METHODS: Among 539 VS patients treated during 1998 to 2008, we identified 296 patients with either bilateral class A (AA) hearing or 1 good ear and 1 deaf ear (AD) according to the American Academy of Otolaryngology-Head and Neck Surgery classification. Patients responded to validated hearing, tinnitus, and dizziness handicap inventories and 2 QoL questionnaires, and the 2 groupswere compared. A reference group of 103 adults filled out the same questionnaires. RESULTS: Forty-nine patients (16.6%) had class AA and 247 patients (83.4%) had class AD hearing. AA patients scored poorer than control subjects without tumor on all handicap questionnaires (P <.001) and a VS-specific QoL instrument (P =.006). Conversely, AA patients scored significantly better than patients with AD on the hearing inventory and the disease-specific QoL instrument (P <.001), but no difference was found between these groups with regard to tinnitus and dizziness. The hearing disability score was approximately 3 times poorer for AA patients compared with control subjects without tumor; a third of AA patients reported a hearing handicap. CONCLUSION: Patients with VS and bilateral class A hearing report significantly poorer hearing handicap than control subjects without tumor but better hearing than those with unilateral deafness. When patients with bilateral class A hearing are counseled, it should be noted that one-third of patients experience self-perceived hearing handicap.