Hearing preservation of post-radiotherapy for acoustic neuroma-A systematic review and meta-analysis

Abdullah Musleh¹Sarah Alshehri^1,2*

• ¹Otolaryngology, Head and Neck Surgery Department of surgery, College of Medicine, king Khalid university, Abha, Saudi Arabia
• ²King Khalid University, Abha, Saudi Arabia

Objective: Acoustic neuroma (AN), or vestibular schwannoma, is a benign tumor of the eighth cranial nerve. Radiotherapy is a key treatment modality. This systematic review and meta-analysis evaluate post-radiotherapy hearing preservation in patients with AN. Methods: Following PRISMA guidelines, 36 studies published from 2011 to 2020 were identified through searches in PubMed, Cochrane, and Semantic Scholar. Data from 3903 patients were analyzed using RevMan 5.3. Random-effects models were applied to account for heterogeneity. Results: The pooled hearing preservation rate post-radiotherapy was 55.9%. Gamma Knife and single-session protocols were associated with higher preservation rates. Male sex was linked to a significantly higher risk of hearing loss (RR = 0.83, 95% CI: 0.69–0.99). Tumor control was achieved in the majority of cases (RR = 2.95, 95% CI: 1.94–4.29). Hearing preservation declined with longer follow-up durations. Secondary outcomes included tinnitus, imbalance, and facial nerve dysfunction. Conclusion: Radiotherapy offers favorable tumor control with variable hearing preservation, influenced by treatment modality, sex, and follow-up duration. These findings inform patient counseling and support the need for standardized outcome measures in future studies.