Acoustic Neuroma Observation Leads to an Increase in Tinnitus Severity: Results of the 2007-2008 Acoustic Neuroma Association Survey

Objective: Tinnitus is a known presenting symptom of acoustic neuromas (ANs); however, observation has previously had an unpredictable impact on tinnitus. Most patients experience improvement with treatment, whereas others may worsen. Therefore, this study was designed to assess the overall impact of observation and treatment on tinnitus outcome in patients with acoustic tumors. Methods: The Acoustic Neuroma Association (ANA) 2007-2008 survey data were used. Tinnitus severity was graded both at presentation and at last follow-up for all patients questioned. The data were analyzed using Student t test and ANOVA analysis. Results: Overall, there were more patients receiving intervention (n = 1138) for their AN than observation (n = 289). Presenting tumor size positively correlated with tinnitus severity score (r2 = 0.01). Regardless of treatment (microsurgery or stereotactic radiation), tinnitus improved at last follow-up and worsened in those that were observed (P = 0.02). When comparing microsurgical options, retrosigmoid and translabyrinthine resections improved tinnitus symptoms (both P < 0.01). Stereotactic radiosurgery had a treatment effect similar to microsurgery. Conclusion: Presenting tinnitus severity correlates strongly with tumor size. Further, regardless of treatment, there appears to be an overall reduction in tinnitus severity for all forms of microsurgery and stereotactic radiosurgery. Importantly, observation leads to a worsening in patient-reported tinnitus severity and therefore should be weighed into the treatment recommendation.