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Video

Otology/Neurotology

(A825) Hearing Outcomes Following Stereotactic Ablative Radiotherapy of Head and Neck Paragangliomas: A Single Institute Experience

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters
Disclosure(s):
Matthew Aschenbrenner, BS: No relevant relationships to disclose.
J Walter Kutz, MD, Jr.: No relevant relationships to disclose.
Brandon Isaacson, MD: No relevant relationships to disclose.


Introduction: To evaluate hearing outcomes following stereotactic ablative radiotherapy (SAbR) of head and neck paragangliomas (HNPGs).

Methods: This is a retrospective cohort study of patients with HNPGs treated with SAbR (25 Gy in 5 fractions) at a tertiary academic center from 2009 to 2020. Inclusion criteria required baseline serviceable hearing (AAO-HNS Class A-B) and serial post-SAbR audiometric follow-up. Main outcome measures were progression to nonserviceable hearing (AAO-HNS Class C-D) and correlation of patient and tumor characteristics with change in word recognition score (∆WRS) and change in pure tone average (∆PTA) for the treated and contralateral untreated ears.

Results: Of 75 patients with HNPGs treated with SAbR, 22 (77.3% female, median age 65 years) met the inclusion criteria. The remaining patients were excluded for the following reasons: baseline non-serviceable hearing (n=30), missing pre/post-SAbR audiograms (n=21), and presence of bilateral HNPGs (n=2). Within a median follow-up of 33.7 months (IQR 19.8-73.6), the median ∆PTA and ∆WRS in the treated ear was 1.13 dB HL/yr (IQR -1.19-2.96) and 0%/yr (IQR 0-0.71%), compared with 1.32 dB HL/yr (IQR 0.95-1.92) and 0%/yr (IQR -0.37-0%) in the contralateral ear. Signed-rank analysis between the treated and contralateral ear revealed no significant differences in ∆PTA (p: 0.137) nor ∆WRS (p: 0.064). Age, race, sex, cranial nerve burden, nor tumor classification were significantly correlated with outcomes of either ear. Five patients developed nonserviceable hearing at a median of 23.6 months post-SAbR (IQR 6.16-41.0). Among those who retained serviceable hearing, median follow-up was 29.6 months (IQR 18.1-54.3). Kaplan-Meier estimated rates of serviceable hearing at 1, 3, and 5 years post-SAbR were 90.9%, 86.6%, and 80.4%, respectively.

Conclusions: The risk of progression to non-serviceable hearing over intermediate-term follow-up is low following SAbR of HNPGs.