BACKGROUND Vestibular schwannoma (VS) is a benign vestibular nerve tumor. The association between tumor size and auditory dysfunction, especially in small VSs, remains unclear. OBJECTIVES To assess audiological changes with increasing tumor size in VS and identify tumor-size thresholds related to hearing impairment. MATERIAL AND METHODS We retrospectively analyzed 430 patients with sporadic VS treated between 2008 and 2025. Patients were classified by Koos grade. Clinical features, pure-tone audiometry, speech discrimination score, auditory brainstem response (ABR), and magnetic resonance imaging findings were reviewed. Multivariate regression and receiver operating characteristic analyses were performed. RESULTS Annual detection of small VS (Koos I-II) increased substantially. Hearing deteriorated with rising Koos grade, showing high-frequency impairment. Pure-tone and speech discrimination were comparable between Koos I and II, whereas ABR differed significantly; over 60% of Koos I patients with serviceable hearing had abnormal ABR. ROC identified thresholds of 17.4 mm for loss of serviceable hearing and 13.4 mm for ABR abnormality. CONCLUSIONS AND SIGNIFICANCE Audiological impairment worsens progressively as VS growth, with clear differences between small and medium-to-large tumors. ABR has superior sensitivity for early retrocochlear dysfunction in small VS and may serve as a preoperative predictor for hearing preservation to support clinical decision-making.
BACKGROUND Intratympanic corticosteroid (ITC) injections are recommended as salvage therapy for patients with incomplete recovery 2-6 weeks after the onset of sudden sensorineural hearing loss (SSHL). AIMS/OBJECTIVES To evaluate patient experiences with ITC therapy and assess treatment side effects. MATERIAL AND METHODS Fifteen patients with SSHL eligible for ITC therapy were prospectively enrolled and received a total of 43 ITC injections. They completed questionnaires on treatment- and disease-related symptoms and side effects, rated using a visual analogue scale (VAS), before and after each injection and at 2-week and 3-month follow-up. Audiometric outcomes were assessed. RESULTS Treatment-related discomfort was low, with mean VAS scores <2 for pain at anaesthesia application and <3 for pain at injection. Twelve patients found the treatment worth the effort, and none regretted participating in the study. Two weeks after the last injection, none of the patients reported residual side effects; however, many patients reported residual hearing loss, sensitivity to sound, tinnitus, and dizziness also at the 3-month follow-up. CONCLUSIONS AND SIGNIFICANCE ITC treatment was well-tolerated by patients. The symptoms reported at 3 months after SSHL onset highlights the need for future SSHL studies to address tinnitus, sound sensitivity, and dizziness in addition to hearing recovery.
