gms | German Medical Science

Objective: Tinnitus is one of the most common complaints of vestibular schwannoma (VS) patients affecting significantly patients’ quality of life before and after surgery. Surgical tumor removal has the potential to improve tinnitus but also the risk of inducing a new-onset tinnitus. Hence, appropriate preoperative counselling of the patients is mandatory. However, so far there is no reliable risk stratification score available.

Methods: The present study develops a risk stratification score (Tuebingen Tinnitus Prediction Score, TTPS) for postoperative tinnitus after retrosigmoid-transmeatal VS surgery. The linear discriminant analysis (LDA) was used to classify 208 patients with unilateral VS concerning the presence of postoperative tinnitus based on their preoperative characteristics (i.e. age, tinnitus, tumor size, hearing impairment) and the expected postoperative outcome (i.e. hearing loss). Classifier was cross-validated by the leave-one-out method. The TTPS was developed by weighting of the LDA coefficients.

Results: The TTPS (range: -5 to +5 points) is the sum of individual points assigned as: age>48 years [-1 point]; presence of preoperative tinnitus [+3]; tumor size: T1/2 [-1] and T4 [+1], preoperative hearing: non-functional (GR3/4) [-1], and deaf (GR5) [-2]; and postoperative hearing: non-functional [+1]. The area under the ROC curve was 0.749 (95%CI [0.784 0.814]; p < 0.001). 86.5% of patients with TTPS≤-1 had no tinnitus. In contrast, 80.8% of patients with TTPS≥4 complained of postoperative tinnitus.

Conclusion: The TTPS is a simple and reliable risk stratification score for postoperative tinnitus after retrosigmoid-transmeatal VS surgery. The use of such a score as the TTPS could improve preoperative counselling of VS patients.