change in hearing during wait and scan management of patients with vestibular schwannoma aim to evaluate hearing changes during wait and scan management of patients with vestibular schwannomasubjects over a 10year period 636 patients have prospectively been allocated to wait and scan management with annual magnetic resonance scanning and audiological examinationresults at the time of diagnosis 334 patients 53 per cent had good hearing and speech discrimination of better than 70 per cent at the end of the 10year observation period this latter percentage was 31 per cent in 17 per cent of the patients speech discrimination at diagnosis was 100 per cent of these 88 per cent still had good hearing at the end of the observation period however in patients with even a small initial speech discrimination loss only 55 per cent maintained good hearing at the end of the observation periodconclusion after comparing the hearing results of hearing preservation surgery and of radiation therapy with those of wait and scan management it appears that in vestibular schwannoma patients with a small tumour and normal speech discrimination the main indication for active treatment should be established tumour growth