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To compare the results of hearing preservation surgeries using different approaches — the enlarged middle cranial fossa approach and the retrosigmoid approach — and different classification systems, stressing the importance of preserving "normal hearing," we performed a retrospective case review in a tertiary care medical center. The charts of 107 patients with vestibular schwannoma who underwent tumor resection were reviewed. Hearing preservation was reported according to 2 different classification systems: the modified Sanna classification and the classification of the American Academy of Otolaryngology-Head and Neck Surgery. The facial nerve results were graded according to the House-Brackmann scale. The hearing preservation rates differed markedly depending on the classification used. We conclude that hearing preservation in acoustic neuroma is a more difficult proposition than most surgeons appreciate, especially in terms of serviceable hearing. [ABSTRACT FROM AUTHOR]