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Stereotactic radiosurgery (SRS) usually provides strong long-term control of a vestibular schwannoma, but it cannot guarantee preserved hearing, quieter tinnitus or better quality of life. The best available figures show hearing preservation declining over time, tinnitus persisting for many patients, and generally small average changes in validated quality-of-life scores. Tumor-control rates are highest for smaller tumors, although the most favorable series excluded many patients with severe brainstem compression.
What the prospective evidence shows
The closest matching prospective longitudinal report followed 79 people who had a pre-SRS PANQOL assessment and at least one follow-up assessment. The mean interval between assessments was 4.6 years. Mean total PANQOL changed by −2 points. Tumor extent and treated volume were statistically associated with the change, but the investigators described the effect as unlikely to be clinically important. A later transition to non-serviceable hearing did not significantly change either total PANQOL or the PANQOL hearing domain. This result comes from a 2025 conference abstract, not a fully verified peer-reviewed journal article, so it should be treated as preliminary.
A separate prospective analysis of 72 participants found that tinnitus distress, measured with the Tinnitus Handicap Inventory (THI), was the strongest predictor of quality of life among the subjective and audiological factors evaluated. In practice, the effect of tinnitus on daily life may matter more to a patient’s overall well-being than a small change in a hearing test alone.
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Hearing outcomes depend heavily on the starting hearing level, the definition of “preserved,” the radiation technique and how long patients are followed. A 2021 CyberKnife cohort included 139 patients with perfect pretreatment word recognition. Hearing was maintained in 50% at three years, 45% at five years and 42% at 10 years. These are time-specific cohort estimates, not a promise for an individual patient.
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Milner and colleagues studied 69 patients with growing tumors: 24 were managed conservatively and 45 received SRS. They concluded that SRS produced similar audiological outcomes to conservative management rather than a significant improvement. Patients who began with better hearing experienced greater deterioration after SRS in that cohort. The finding does not mean that good baseline hearing makes SRS inappropriate; it means that baseline hearing must be included when discussing the likely trade-off.
| Study or cohort | Participants and baseline | Follow-up result | Interpretation |
|---|---|---|---|
| CyberKnife cohort, 2021 | 139 patients; perfect pretreatment word recognition | Hearing maintained in 50% at 3 years, 45% at 5 years and 42% at 10 years | Preservation was lower with longer follow-up |
| Milner et al., 2018 | 69 patients with growing tumors; 24 conservative management and 45 SRS | SRS did not significantly improve audiological outcomes versus conservative management | Better baseline hearing was associated with greater deterioration after SRS |
Tinnitus often persists and occasionally changes after treatment
In a 2022 radiotherapy cohort, tinnitus was already present in 71.4% of patients in the SRS or hypofractionated-radiotherapy group before treatment. After treatment, 6.1% reported improvement and 4.1% developed new tinnitus. Because the group combined SRS with hypofractionated radiotherapy, the percentages should not be treated as an SRS-only prediction.
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Tinnitus severity is not captured by a simple yes-or-no symptom count. THI scores measure distress and functional impact, which is why the prospective tinnitus analysis identified THI as the strongest quality-of-life predictor. A person whose tinnitus is stable but highly distressing may have a larger quality-of-life burden than someone with a louder sound that is less intrusive.
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Vestibular schwannoma studies use instruments such as PANQOL and SF-36, while hearing studies may use pure-tone averages, speech-discrimination or word-recognition scores, and AAO-HNS or Gardner-Robertson hearing classes. These measures answer different questions. A controlled tumor can coexist with hearing loss or bothersome tinnitus, and a small hearing change may not produce a measurable change in a total quality-of-life score.
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In the 79-patient prospective PANQOL series, the average change of −2 points over a mean 4.6 years was small, and the authors judged the associations with tumor extent and treated volume unlikely to be clinically important. Hearing becoming non-serviceable did not significantly alter total or hearing-domain PANQOL scores in that analysis. That does not establish that hearing loss is unimportant; it shows that a group-average questionnaire score may not reflect every patient’s experience.
Tumor control is high, especially for smaller tumors
A 2026 size-stratified series of 160 SRS-treated patients reported 98.1% overall local control. Five-year progression-free survival was 100% for intracanalicular tumors, 98.9% for intermediate-size tumors and 96.6% for larger selected tumors.
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| Tumor category | Five-year progression-free survival |
|---|---|
| Intracanalicular | 100% |
| Intermediate-size | 98.9% |
| Larger selected tumors | 96.6% |
| All size groups combined | 98.1% overall local control |
The larger-tumor estimate applies only to selected patients. The series excluded many people with severe brainstem compression, so its results cannot be generalized to every large vestibular schwannoma. “Local control” or “progression-free survival” means that the tumor did not meet the study’s progression definition during follow-up; it does not mean that the tumor disappears immediately or that every MRI will show shrinkage. The available figures establish control rates, not a universal percentage of tumors that shrink.
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Why published percentages do not line up
Before comparing two SRS studies, check all of the following:
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- Baseline hearing: Perfect word recognition, serviceable hearing and a mixed hearing class are different starting points.
- Outcome definition: “Hearing preserved” may mean a hearing class, a pure-tone average or a speech-recognition threshold.
- Tumor anatomy: Intracanalicular, intermediate and larger tumors have different control estimates; location and brainstem relationship also affect selection.
- Technique and dose: CyberKnife, single-fraction SRS and hypofractionated schedules should not be assumed equivalent.
- Follow-up duration: Hearing preservation can fall between three-, five- and 10-year assessments.
- Control definition: Progression-free survival and local control are not the same as radiographic disappearance.
- Study design: Many cohorts are retrospective, whereas the closest matching longitudinal PANQOL report is currently a conference abstract.
- Selection effects: Patients chosen for SRS may differ from those observed or referred for surgery in age, tumor growth, size and baseline function.
Questions to take to an SRS consultation
- Which hearing measure will be used before and after treatment, and what would count as meaningful preservation?
- How does the tumor’s size, location, growth pattern and brainstem relationship compare with the patients in the clinician’s cited series?
- What dose and treatment schedule are proposed, and what follow-up schedule will include audiometry, tinnitus assessment and MRI?
- How will tinnitus distress be tracked, rather than simply recording whether tinnitus is present?
- What is the plan if the tumor progresses or hearing declines?
The evidence supports SRS as a highly effective tumor-control treatment in appropriately selected patients, not as a guaranteed hearing-preservation or tinnitus-cure procedure. Individual counseling should weigh baseline hearing, tumor growth and size, age, location, dose, technique and the length of follow-up against the person’s priorities.
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