OBJECTIVE: The aim of this study was to compare quality of life (QOL) in small 
unilateral vestibular schwannoma (VS) patients managed by microsurgery, 
radiotherapy or observation.
STUDY DESIGN: A retrospective chart review.
METHODS: The study included a total of 142 patients with VS stage 1 or 2 
according to the Koos classification and treated between January 2004 and 
December 2015. Microsurgery, radiotherapy and observation groups comprised 43, 
46 and 53 patients, respectively. All patients completed four QOL 
(questionnaires: Short-Form Health Survey 36, Hearing Handicap Inventory, 
Tinnitus Handicap Inventory and Dizziness Handicap Inventory Short-Form). 
Clinical symptoms and QOL were compared among groups.
RESULTS: The average time interval between management and filling in the 
questionnaires was 66 months. There was no difference in QOL between the three 
groups on any of the four questionnaires. The most debilitating symptom was 
vertigo for all three groups. Tinnitus was a pejorative factor in the surgery 
group. Hearing level was deteriorated after microsurgery but there was no 
significant difference between the radiotherapy group and the middle fossa 
approach.
CONCLUSION: Patients with small VS stage 1 and 2 had similar QOL, irrespective 
of management by observation, radiotherapy or microsurgery. The overall 
predictor for long-term reduced QOL was vertigo. Vestibular rehabilitation could 
improve QOL in symptomatic patients.