Patient Selection and Method of Evaluation for Hearing Preservation in Acoustic Neuroma Surgery

Abstract

The goals of acoustic neuroma surgery are safe and accurate total tumor resection, normal facial nerve preservation, and hearing preservation. With the advances in extremely careful and meticulous microtechniques, hearing preservation has become possible in a high percentage of cases. This article deals with the criteria for patient selection in order to preserve good hearing function and discusses the key factors for hearing preservation and preoperative-postoperative evaluation of hearing function. Our criterion for selection of candidates for hearing preservation has been pure tone audiogram better than 50 dB loss and speech discrimination score better than 50 percent. This 50/50 criterion is still the standard; however, some patients with scores worse than 50/50 could be candidates for hearing preservation. Increasing clinical experience has indicated that the current American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification should be modified to divide C and D classes more precisely into several subtypes for better assessment of patient selection for hearing preservation.