best option to preserve hearing?

[larryw]

I was quite recently diagnosed with a small (.3 cm) acoustic neuroma ("intercanalicular"). Despite the size, I have already experienced significant asymmetrical hearing loss in that ear, which is why I was sent in for an MRI in the first place (I haven't had any other symptoms, though I am told that my balance nerve is certainly already affected). I am almost 62, so my initial thought has been that the long-term possible side effects of radiosurgery would be preferable to the traumatic nature of microsurgery.

I have seen two doctors (one in "otolaryngology," the other in "otorhinolaryngology") who have each performed AN surgery "hundreds" of times.

One recommended "watchful waiting" and another MRI in six months, and described the various options for surgery if the AN continues to grow. He doesn't do the stereotactic radiation surgery, but has a colleague who does.

The other told me that my hearing might deteriorate further in six months, so I should consider doing something sooner if I wanted the best chance of preserving my hearing in the affected ear. He suggested a 70% success rate in preserving hearing with microsurgery (middle fossa), but only 40% with the gamma knife. Similarly, he doesn't do the radiosurgery, but has a colleague who does.

For various reasons, preserving whatever hearing I have is quite important to my work and life, and these numbers are far more depressing than I had been led to believe from preliminary reading and listening to others' experiences in a local support group. I am also quite depressed by the thought that waiting six months might result in a further, irreversible decline in my hearing potential.

Can anyone direct me to some reliable statistics on hearing loss/preservation with microsurgery vs. radiosurgery? Do these numbers sound pretty much in line with what others have heard from their physicians?

Thanks, Larry

[TJ]

Larry

Of course I am not a doctor, but I have talked with many.  Most doctors say that after radiation you will have about 93-97% chance of having serviceable hearing.  Depending on the size of the AN.  The smaller the AN the higher percentage of saving hearing.

Hope this helps

TJ

[arizonajack]

Depends on what you mean by significant hearing loss.

If you have enough hearing left that can be assisted with a hearing aid, then I suggest not waiting and get whatever treatment method has the best chance of preserving the hearing.

Your situation parallels mine. By the time I was diagnosed with my AN my hearing was pretty much gone on that side so there was no helping it anyway. I opted for watch and wait. 6 months later the tumor had grown and there was no hearing at all on the AN side.

Do as much research as you can as quickly as you can.

Here's an article about Gamma Knife and hearing preservation. It's impressive.

http://www.panarabneurosurgery.org.sa/journal/October2008/p1-10%20(551).pdf

Whether you opt for surgery or radiation, my vote is kill it while it's small.

[larryw]

Jack, the article for which you provided the link is VERY helpful. I have seeing good things said about the people at the University of Pittsburgh medical center in various discussions on this forum, and the fact that they are prominently mentioned in the article leads me to think about Dr. Lunsford at UPMC as a potentially ideal person to do the radiosurgery.

Larry

[jbbrown15]

I'm not sure where you are, but Dr. David Andrews at Thomas Jefferson University Hospital in Philadelphia also does fractionated stereotactic raditation therapy with good hearing results.  I lost my hearing, but my tumor was 2.9 cms.

[arizonajack]

Jack, the article for which you provided the link is VERY helpful.

Now there's a 2012 article available about 10 year follow up studies of GK patients.

http://thejns.org/doi/pdf/10.3171/2012.7.GKS12783

[larryw]

Well, I went to see a doctor who does radiosurgery, and he said that I am not a good candidate for this. My AN is so small that it would be hard to pinpoint it using radiation, and the collateral damage (my term, not his) to the cochlea would more likely than not cause a further deterioration of my hearing.

I few days ago, I was gravitating strongly toward radiosurgery; now, I feel totally confused. It seems really drastic to go for microsurgery for a small AN with the hope that it will preserve my hearing in the affected ear, when there is also a chance that it will destroy it completely and possibly cause problems with balance, facial nerve, tinnitus, and headaches, none of which are currently affecting me (well, my balance is almost affected, but I can't point to anything obvious).

Larry

[PaulW]

Did the radiation specialist perform Gamma knife or Cyberknife or something else?
If it was something else he may not be able to reduce the radiation dose to the cochlear enough.
Radiation dose to the cochlear is linked to hearing preservation.

[larryw]

I am driving to Pittsburgh for a consultation with Dr. Lunsford. I sent him my MRIs and other info, and he gave me an encouraging reply. I know that some people here have opted for surgery after a phone conversation, but I really need to meet someone in person.

Wish me luck!

Larry

[robinb]

I had GK w/Dr. Lunsford in January- highly recommend; you can see my posts on the experience in the radiosurgery section. With a small AN, I ruled out surgery immediately, although I had a consult w/Dr. Friedman at House anyway since I live in CA. Due to that I didnt have the luxury of in person consults for GK, so had to base my selection decsion on other factors.

There are many studies on hearing preservation, but what I have found is w/GK and CK, what you go in with is hoefully what you retain.

[It is what it is]

Hi, I also had a small AN and hearing preservation was extremely important to me, so I decided not to wait for it to worsen.  I consulted with doctors specializing in the treatments for AN and asked for their statistics for hearing preservation after they saw my MRI.  My choice was middle fossa surgery with House Ear Institute.  My hearing is the same as it was prior to surgery and I am very very grateful!  I wish you well on whatever treatment option you choose.

 Karen

[larryw]

Well, I have now been to four specialists, and the recommndations are watchful waiting six months, watchful waiting twelve months, microsurgery soon, and radiosurgery soon. So, I have the whole range of options available, and I end up feeling quite confused. One thing that I hadn't realized earlier is that the success rate in hearing prevention with gamma knife surgery drops off considerably for those over 50 or 60.

Larry