Untreated vestibular schwannomas: vertigo is a powerful predictor for health-related quality of life

The aim of the present study was to characterize the relation between quality of life (QOL) and the four major complaints (hearing loss, tinnitus, vertigo, and unsteadiness) caused by unilateral vestibular schwannomas (VS) in a cohort of well-characterized untreated patients. One hundred ninety-nine consecutive patients (91 men, 108 women) with a mean age of 56.9 years were studied prospectively during the 4-year period from 2001 to 2004. The average length of time from symptom onset to the radiological diagnosis was 4.2 years. The patients were subject to a standardized examination including magnetic resonance imaging, evaluation of hearing acuity, balance function by stabilimetry, and a visual analogue scale self-evaluation of tinnitus and vertigo. Furthermore, the patients responded to two questionnaires: Short-Form 36 and the Glasgow Benefit Inventory. A reference population was recruited from 80 adults who visited Haukeland University Hospital as nonpatients or nonstaff members. All data were recorded prospectively in a customized case report form. Statistical analysis was performed with SPSS software. The response rates of the Short-Form 36 and Glasgow Benefit Inventory questionnaires were 91.5 and 89.9%, respectively. According to the Short-Form 36 questionnaire, the patients scored significantly below that of expected norms with the exception of physical function and mental health. Patients report negative benefit on the general and physical sections of the Glasgow Benefit Inventory questionnaire. Regression analysis showed that vertigo had a strong negative impact on QOL, whereas unilateral hearing loss and tinnitus had less impact on QOL. Vertigo is the symptom causing the most pronounced negative effect on QOL in patients with VS. The more frequent VS symptoms, unilateral hearing loss and tinnitus, seem to be less important in the patients' perception of QOL as evaluated by the questionnaires used in this study. If vertigo could be relieved by treatment, this symptom should be a primary focus when discussing treatment options in small- to medium-sized VS.