Intracochlear schwannomas confined to the otic capsule

OBJECTIVE: To determine the natural history and management for patients with intracochlear schwannomas. STUDY DESIGN: Retrospective case series of intracochlear schwannomas confined to the otic capsule. SETTING: Tertiary referral center. PATIENTS: Ten patients were found to have schwannomas limited to the cochlea from 1998 to 2009. INTERVENTIONS: All subjects underwent at least 1 magnetic resonance imaging (MRI) study and had at least 1 audiogram. Two patients underwent a transotic excision for intractable symptoms. MAIN OUTCOME MEASURES: Presenting symptoms, initial and follow-up MRI findings, audiometric testing results, and need for surgical intervention were recorded for each subject. RESULTS: Hearing loss was present in all 10 patients at their initial presentation. Tinnitus was present in 50% of patients, and vertigo was present in 30% of patients. No patient presented with aural fullness or facial weakness. The pattern of hearing loss seemed to correlate with the location of the lesion within the cochlea. Of the 9 patients that had follow-up MRIs, 3 patients showed tumor growth. Two of the 10 patients underwent surgical excision for intractable vertigo that resulted in resolution of symptoms. CONCLUSION: Hearing loss is the most common finding in patients with intracochlear schwannomas, followed by tinnitus and vertigo. If the patient does not have symptoms of intractable vertigo, observation with serial MRI scans is indicated. Surgical excision should be reserved for patients with intractable vertigo or with significant tumor growth.