The Sound of Happiness: Hearing-Related Quality of Life and Patient Satisfaction with Management Decision-Making in Vestibular Schwannoma

Introduction: Patient satisfaction is increasingly emphasized in all aspects of neurosurgical care; however, strategies for identifying patients at highest risk for treatment dissatisfaction remain sophomoric. The goal of the present study was to assess in a large sample of vestibular schwannoma (VS) patients the relationship between hearing loss, patient satisfaction with shared decision-making for initial management strategy, and associated impacts on hearing-related quality-of-life (QOL).

Methods: Prospective, observational, multicenter, multinational, cross-sectional study, analyzed via multivariable linear and logistic regression.

Results a total of 422 VS patients with formal audiometry within 1 year of survey date were identified. Median age was 54 (range, 12–82); 223 (53%) were female. At the time of survey, 386 individuals responded to the question “Are you happy with the treatment type (surgery, radiation, or observation)?,” of whom 26 (7%) indicated dissatisfaction with the elected management strategy. Hearing loss domains significantly associated with dissatisfaction, included word recognition score (WRS; p < 0.0001), pure tone average (PTA; p = 0.0003), AAO-HNSF Hearing Class (p = 0.003), subjective hearing loss severity (p = 0.0005), and loss of ipsilateral telephone. Subjective hearing loss and telephone use were co-linear with WRS, PTA, and derived parameters. Neither tinnitus nor regular hearing air use was not significantly associated with treatment dissatisfaction. Adjusting for age and sex, the odds ratio for treatment dissatisfaction with Class B or worse hearing, as compared with Class A, was 4.1 (95% CI = 1.3–17.6, p = 0.01). Unhappiness with initial management strategy was significantly associated with other unfavorable QOL outcomes, including adverse impacts on personal relationships or conversations due to hearing loss (p = 0.01, p = 0.005).

Conclusion: Patient dissatisfaction with initial management strategy is uncommon, occurring in 5 to 10% of all VS patients. Hearing loss, even at a modest degree of disability, appears to be the predominant driver of dissatisfaction, particularly when associated with adverse impacts on personal relationships or conversations.