The authors reviewed published literature reporting hearing outcomes in patients after retrosigmoid (RS) resection of vestibular schwannoma (VS). Aggregate hearing preservation of 31% and 35% under fixed and random models respectively was observed in the 2034 patients meeting eligibility criteria and with serviceable preoperative hearing. The study concluded that rates of postoperative hearing preservation were dependent on preoperative tumour size. Rates of hearing preservation were 57% for intracanalicular tumours versus 37% for small and 12% for large (>20mm) tumours, respectively. This study has applied excellent analytic and statistical techniques to review literature published over a 21-year period. However, the main limitation of this study is due to the inconsistent reporting of preoperative size of the vestibular schwannoma in the published studies which were reviewed by the authors.