Tinnitus is one of the most common and distressing symptoms experienced by patients with vestibular schwannoma (VS), yet its long-term course following surgical treatment has remained poorly defined. A newly published study in Scientific Reports provides important new insight into which patients are most likely to experience improvement, worsening, or new-onset tinnitus after microsurgical resection.
The retrospective analysis evaluated long-term tinnitus outcomes in 450 patients who underwent vestibular schwannoma surgery via the retrosigmoid approach between 2018 and 2024.
Using questionnaire-based follow-up at least six months postoperatively, the investigators examined clinical and surgical factors—including age, tumor size, hearing status, facial nerve function, and tinnitus characteristics—to identify predictors of postoperative tinnitus outcomes.
Tinnitus Is Common Before and After Surgery
Among the 450 patients included in the study, 297 (66.0%) reported tinnitus prior to surgery, consistent with prior estimates that tinnitus affects the majority of individuals with vestibular schwannoma. Preoperative tinnitus was more common in male patients and in those with smaller tumors.
After surgery, the overall incidence of tinnitus increased significantly, highlighting that surgical intervention does not uniformly resolve tinnitus and may, in some cases, exacerbate or precipitate symptoms.
In patients who had tinnitus prior to surgery, outcomes varied widely. Some experienced improvement or resolution, while others reported persistent or worsened symptoms. Among those without tinnitus preoperatively, nearly half developed new-onset tinnitus following surgery.
This variability underscores why predicting tinnitus outcomes is clinically important for counseling patients and setting realistic expectations before treatment.
Hearing Status, Age, and Tinnitus Pattern Matter
Several factors emerged as significant predictors of long-term tinnitus outcomes.
One of the most consistent findings was the role of preoperative hearing status. Patients with better hearing before surgery faced a greater risk of both tinnitus worsening and new-onset tinnitus following surgery. Importantly, this association remained even when other factors—such as age, tumor characteristics, and nerve function—were taken into account.
Age also played a notable role. Older patients were more likely to experience tinnitus improvement and less likely to develop new-onset symptoms after surgery. In contrast, younger patients were more prone to persistent or newly developed tinnitus. The investigators suggest that age-related differences in neural plasticity may help explain this effect, as younger nervous systems may be more prone to maladaptive auditory reorganization following changes in auditory input.
Interestingly, patients who described their tinnitus as intermittent before surgery were far more likely to experience postoperative improvement than those with continuous tinnitus. Patients with intermittent tinnitus were much more likely to see improvement after surgery. According to the researchers, this may indicate that the underlying neural changes in intermittent tinnitus are less permanent and more capable of recovery than those associated with continuous symptoms.
Facial nerve function showed an association with tinnitus outcomes in univariate analysis, but this relationship did not remain significant after adjusting for other factors. The investigators note that facial nerve outcomes may be confounded by tumor size and hearing status rather than directly influencing tinnitus perception.
Hearing Preservation Does Not Increase Tinnitus Risk
One clinically reassuring finding was that hearing preservation itself was not associated with worse tinnitus outcomes. Among patients with serviceable hearing before surgery, preserving hearing did not increase the likelihood of tinnitus worsening or new-onset tinnitus.
This challenges concerns raised in earlier studies suggesting that attempts at hearing preservation might exacerbate tinnitus and supports continued efforts to preserve auditory function when clinically appropriate.
Taken together, the findings suggest a more nuanced relationship between hearing and tinnitus than previously assumed. While better preoperative hearing appears to increase tinnitus risk, the act of preserving hearing during surgery does not appear to independently worsen tinnitus outcomes.
Implications for Patient Counseling and Long-Term Care
The study provides practical insights for clinicians managing vestibular schwannoma patients. Patients who are younger, have serviceable hearing, or report continuous tinnitus before surgery may be at higher risk for persistent or worsened tinnitus and may benefit from early counseling and long-term tinnitus management strategies. Conversely, older patients and those with intermittent tinnitus may have a more favorable prognosis.
Importantly, the investigators emphasize that tinnitus should be considered a central quality-of-life outcome—not merely a secondary symptom—when discussing treatment options such as surgery, radiotherapy, or observation.
While the study’s use of a simplified, non-validated tinnitus questionnaire represents a limitation, its large sample size and extended follow-up make it one of the most comprehensive examinations of long-term tinnitus outcomes in vestibular schwannoma surgery to date. The inclusion of tinnitus frequency as a predictive factor is a particularly novel contribution that may guide future research.
As survival and facial nerve outcomes continue to improve for vestibular schwannoma patients, understanding and addressing tinnitus will remain a critical component of comprehensive, patient-centered care.
Citation
Geng H, Zhang B, Tang Y, et al. Predictors of long-term postoperative tinnitus outcomes in vestibular schwannoma patients. Scientific Reports. 2025;15:44258. https://doi.org/10.1038/s41598-025-27829-6
