The paper reviews the literature and presents the author’s own experience with more than 100 patients with vestibular schwannoma, operated on by the trans-labyrinth approach. The complicated problem of saving the hearing in removal of vestibular schwannoma is analyzed. The mechanism of origin of the hearing disorder before the operation is analyzed as well as that of hearing lost during the operations, performed with the aim to save hearing. Prognostic indices for saving the hearing are discussed in detail, and the surgical techniques for saving the hearing including preoperative monitoring are outlined and realistic possibilities to save the hearing from the long-term point of view and analyzed in detail. The author arrives at the conclusion that in many patients, who fulfill the criteria, a measurable hearing is saved, but normal or exploitable hearing is saved in a very small number only. The long-term outcome is even worse.

        Key words: vestibular schwannoma, hearing preservation.