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Objectives: To study the effect of pre-operative hearing level and tumour size on the hearing outcome of hearing preservation surgery for vestibular schwannoma.Study design and setting: A review of literature conducted at Gruppo Otologico, a tertiary referral centre for neurotology and skull base surgery.Results: A total of 1993 patients in 16 publications addressing the topic of hearing preservation surgery in vestibular schwannoma were analysed. The American Academy of Otolaryngology–Head and Neck Surgery hearing classification system was the classification upon which we based our analysis.Conclusion: Defining hearing preservation as class-A hearing, there was a strong inverse relationship between pre-operative hearing and post-operative hearing levels and between tumour size and post-operative hearing levels. [ABSTRACT FROM AUTHOR]