Effect of post-operative analgesia duration on post-tonsillectomy readmission rate: comparison of five-day and 14-day regime

2007 ◽  
Vol 121 (10) ◽  
pp. 968-972 ◽  
Author(s):  
Y M Takwoingi ◽  
M Shykhon ◽  
M Wake
Keyword(s):  
Readmission Rate ◽  
Operating Theatre ◽  
Bipolar Diathermy ◽  
Readmission Rates ◽  
Operating Technique ◽  
Significant Difference ◽  
Secondary Haemorrhage ◽  
A Prospective Study ◽  
Rate Comparison ◽  
Cold Steel Dissection

Objectives: To determine whether the introduction of a 14-day post-tonsillectomy analgesic regime would be associated with a statistically significant decrease in readmission rate.Method: A comparative study of tonsillectomy patients over two study periods. A retrospective review was undertaken of 342 patients (group one, five-day analgesic regime) who had undergone tonsillectomy. A prospective study was undertaken of 228 patients (group two, 14-day analgesic regime). The readmission rates for the two study periods were compared.Results: The median age of group one patients was 8.1 years (range, zero to 43 years). In this group, ‘cold steel’ dissection was performed in 177 patients (52 per cent) and bipolar dissection in 165 patients (48 per cent); seven patients suffered reactionary haemorrhage, all from the cold steel dissection group. The median age of group two patients was 8.0 years (range, one to 47 years). In this group, cold steel dissection was performed in 103 patients (45 per cent) and bipolar dissection in 125 patients (55 per cent); there were no cases of reactionary haemorrhage. The readmission rate for group one was 9.9 per cent (34 patients), with 2.1 per cent (seven patients) returning to the operating theatre for control of haemorrhage. In group two, 8.8 per cent (20 patients) were readmitted and 1.3 per cent (three patients) returned to the operating theatre. The main reason for readmission was secondary haemorrhage: 9.1 per cent from group one and 8.3 per cent from group two. No significant difference in readmission was found between the 5-day analgesia and the 14-day analgesia groups (p=0.443). However, there was a significant difference between the diathermy and cold steel dissection groups (p<0.001). Patients undergoing bipolar diathermy were almost six times more likely to be readmitted than those undergoing cold steel dissection (odds ratio 5.78). The average time to readmission after tonsillectomy did not significantly differ between the two groups.Conclusion: The post-tonsillectomy readmission rate was not affected by the duration of post-operative analgesia; however, operating technique did have an effect.

scholarly journals Incidence of haemorrhage after tonsillectomy

2012 ◽  
Vol 18 (1) ◽  
pp. 55-58
Author(s):  
Mohammad Shah Kamal ◽  
Rubina Farzana ◽  
Abu Hena Mohammad Parvez Humayun ◽  
AHM Zahurul Huq ◽  
Md Mostafizur Rahman
Keyword(s):  
Diclofenac Sodium ◽  
Bipolar Diathermy ◽  
Life Threatening ◽  
Secondary Haemorrhage ◽  
Common Operation ◽  
Mouth Wash ◽  
A Prospective Study ◽  
Dissection Technique ◽  
Cold Steel Dissection

Tonsillectomy is probably the most common operation performed by an Otolaryngologist. One of the most significant complications is post-operative haemorrhage. Episodes of post tonsillectomy haemorrhage are unpredictable and sometimes life threatening. The aim of the present study was to find out the incidence of reactionary haemorrhage after tonsillectomy. A prospective study was conducted at Shaheed Shamsuddin Ahmed Hospital, Sylhet from April 2010 to March 2011. We had selected 112 cases undergoing tonsillectomy. Tonsillectomy was done by cold steel dissection technique and bipolar diathermy haemostasis. Post operatively every patient was treated with pain killer (diclofenac sodium and paracetamol), antibiotics (amoxicillin and cloxacillin) and hydrogen peroxide mouth wash. Postoperative follow-up was done till the tonsillar fossa healed. The incidence of reactionary haemorrhage was 2.68%, primary and secondary haemorrhage was 0%. In our series haemorrhage (2.68%) was higher than that reported in most publications and may be due to inadequate per-operative haemostasis. DOI: http://dx.doi.org/10.3329/bjo.v18i1.10415  Bangladesh J Otorhinolaryngol 2012; 18(1): 55-58

Bipolar diathermy or ligation for haemostasis in tonsillectomy? A prospective study on post-operative pain

1992 ◽  
Vol 106 (1) ◽  
pp. 21-22 ◽  
Author(s):  
A. T. K. Choy ◽  
A. P. Su
Keyword(s):  
Prospective Study ◽  
Controlled Trial ◽  
Blind Study ◽  
Bipolar Diathermy ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Secondary Haemorrhage ◽  
A Prospective Study ◽  
Single Blind

AbstractForty-nine children for tonsillectomy were entered in a prospective controlled single blind study to compare the post-tonsillectomy morbidity of bipolar diathermy as opposed to ligation for haemostasis. We found no significant difference in post-operative discomfort nor reactionary or secondary haemorrhage in the two methods used. This is the first controlled trial where bipolar, rather than unipolar diathermy is used, and compared with ligation in the operation of tonsillectomy

scholarly journals Don't Leave Without Them: Dispensing asthma medications to pediatric patients upon discharge is associated with decreased hospital readmissions

2012 ◽  
Vol 3 (4) ◽  
Author(s):  
Kelly J. Hiteshew ◽  
Thaddeus Franz ◽  
Kristen Lamberjack ◽  
Aleda M.H. Chen
Keyword(s):  
Readmission Rate ◽  
Chart Review ◽  
Transitional Care ◽  
Hospital Readmissions ◽  
Original Research ◽  
Intervention Period ◽  
Readmission Rates ◽  
Intervention Phase ◽  
Patients Âgés ◽  
Significant Difference

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution's outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During the intervention phase, pharmacists promoted use of the outpatient pharmacy by patients admitted for these conditions using multiple methods. In each chart review, the patients readmitted for asthma or wheezing within thirty days were classified as either outpatient pharmacy users (OPP users) or non-OPP users. Differences in readmission rates between OPP users and non-OPP users, as well as differences in overall OPP utilization, were analyzed before and during the intervention phase using a Chi-square test. Results: The initial chart review found no significant difference in thirty day readmission rates between OPP users and non-OPP users (6.2% and 7.5%, respectively; x2 = 1.15; p = 0.274). The number of OPP users increased significantly from the first chart review to the second (11.8% and 45.9%, respectively; x2 = 929.04, p < 0.001). The second chart review revealed that OPP users had a significantly lower readmission rate than non-OPP users during the intervention phase (2.3% and 10.9%, respectively; x2 = 52.5; p < 0.001). Conclusion: Obtaining discharge medications from the OPP was associated with a lower thirty-day readmission rate in children with asthma. Promoting use of the OPP for transitional care should continue to be part of future efforts to decrease hospital readmissions.   Type: Original Research

High Readmission Rates Are Associated with a Significant Economic Burden and Poor Outcome in Patients with Grade 3/4 Acute GvHD

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2061-2061
Author(s):  
Fiona L Dignan ◽  
Michael N Potter ◽  
Mark E Ethell ◽  
Joy Brennan ◽  
Louise McNamara ◽  
...  
Keyword(s):  
Stem Cell ◽  
Readmission Rate ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Readmission Rates ◽  
Significant Difference ◽  
The Mean ◽  
Grade 3 ◽  
Mean Cost ◽  
Johnson Company

Abstract Abstract 2061 The impact of graft versus host disease (GvHD) on readmission rates following allogeneic stem cell transplantation (SCT) has not been reported. We hypothesised that patients with GvHD would have a higher readmission rate than patients without GvHD. To test this hypothesis a retrospective review was undertaken of 187 consecutive patients who underwent allogeneic SCT from 1/1/2006 to 30/4/2009 at the Royal Marsden Hospital, UK. Data were collected from the electronic patient record. The study was approved by the hospital audit committee. Patient characteristics: male 113(60%), median age 47 yrs (17–70), diagnosis: acute leukaemia 123 (66%), chronic leukaemia 22 (12%), lymphoma 23 (12%), myeloma 12 (6%), other 7 (4%), donor: sibling 60 (32%), unrelated 115 (61.5%), cord 12 (6.5%), stem cell source: PBSC: 158 (84.5%), BM 17 (9%), cord 12 (6.5%); donor sex: M 111(59.5%), F 64 (34%), cord 12 (6.5%); match: full 130 (69.5%), mismatch 45 (24%), cord 12 (6.5%), conditioning intensity: full 73 (39%), reduced 114 (61%); use of alemtuzumab 113 (60%); GvHD prophylaxis: cyclosporine 116 (62%), mycophenolate 32 (17%), cyclosporine and methotrexate 26 (14%), other 13 (7%). Median follow up was 3.8 (2.2–5.5) yrs from transplant. 118/187 (63%) of patients developed GvHD. There was no significant difference between patients with or without GvHD except for increased use of alemtuzumab in the non-GvHD group (71% v 54%, p=0.024). GvHD was diagnosed clinically at the transplant centre. Biopsies were undertaken if the diagnosis was unclear. Glucksberg criteria were used to stage acute GvHD (aGvHD). NIH criteria were used to diagnose chronic GvHD (cGvHD). 45/118 (38%) had biopsy-proven GvHD. 88/187 (47%) had aGvHD (grades: 1 – 17 (9%), 2 – 43 (23%), 3 – 15 (8%), 4 –13 (7%)). 58/187 (31%) of patients had cGvHD. 36/187 (19%) had both acute and chronic GvHD (52 (29%) had aGvHD alone, 22 (12%) had cGvHD alone). 8 developed GvHD following donor lymphocyte infusion. 104/118 (88%) required steroid treatment. 61/118 (52%) commenced steroids within 100 days of transplant. 61/118 (52%) were steroid refractory. 5 patients had received a second allogeneic transplant for relapse to induce GvHD and graft versus malignancy effect. The median duration of initial transplant admission was 31 days (20–138) in GvHD group compared to 32 days (16–103) in non GvHD group (p=NS). 14 patients died during initial admission (5 in GvHD group, 9 in non-GvHD group) and were excluded from readmission analysis. The overall readmission rate was higher in GvHD patients (89% (101/113) v 41/60 (68%), p=0.001). In the first 100 days post transplant, 42/56 (75%) of patients who had started steroids were readmitted compared to 60/117 (51%) in patients who started steroids after day 100 or had no GvHD (p=0.003).Critical care unit admission was higher in the GvHD group (38/113 (34%) v 7/60 (12%),p=0.002). The mean total number of admission days was higher in the GvHD group (42 days v 18 days, p<0.001). 337/455 (74%) of readmission episodes and 231/305 (76%) of infection-related admissions were in the GvHD group. Patients with grade 3/4 GvHD had a higher readmission rate (96%) than grade 1/2 GvHD patients (88%) or patients with no aGvHD (74%). The mean total number of admission days was 57 days in grade 3/4 GvHD compared to 37 days in grade 1/2 GvHD. (p=0.054). Costs were calculated based on the 2010 hospital tariff (€600/inpatient day and €2295/CCU day). The mean cost of readmission was higher in GvHD patients (€32217) than in non-GvHD patients (€15622) (p=0.003). Mean cost was higher in grade3/4 GvHD (€44535) than in grade 1/2 GvHD (€27001) (p=0.032). These figures do not include drug or procedural costs. Overall survival was 42% at 2 years. Survival was higher in the GvHD group (48%) than in the non GvHD group (30%) (p=0.006). Survival was higher in those with grade 1/2 GvHD (55%) compared to those with grade 3 or 4 GvHD (14%) (p<0.001). There was no significant difference in survival in those with grade 1/2 GvHD (55%) and those with no GvHD (43%) (p=0.15). In conclusion, patients with GvHD had significantly higher readmission rates and longer duration of admission than those without GvHD. Despite the high readmission rate, patients with grades 1/2 GvHD had improved survival. Patients with grade 3/4 GvHD had a very high level of readmission and poor outcome. Improving strategies for managing GvHD may help to reduce post transplant readmission rates and the associated burden on the healthcare system. Disclosures: Dignan: Therakos, a Johnson and Johnson company: Honoraria, Research Funding. Shaw:Therakos, a Johnson and Johnson company: Honoraria, Speakers Bureau.

scholarly journals Guillotine versus dissection tonsillectomy: randomised, controlled trial

2012 ◽  
Vol 126 (11) ◽  
pp. 1142-1149 ◽  
Author(s):  
S J Frampton ◽  
M J A Ward ◽  
V S Sunkaraneni ◽  
H Ismail-Koch ◽  
Z A Sheppard ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Blood Loss ◽  
Operative Time ◽  
Controlled Trial ◽  
Operative Blood Loss ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Secondary Haemorrhage ◽  
Randomised Controlled ◽  
Cold Steel Dissection

AbstractObjective:This trial aimed to compare the guillotine technique of tonsillectomy with ‘cold steel’ dissection, the current ‘gold standard’.Design:A single centre, randomised, controlled trial.Methods:One hundred children aged 3 to 11 years who were listed for bilateral tonsillectomy were recruited. Patients had one tonsil removed by each technique, and were blinded to the side. The operative time, intra-operative blood loss, haemostasis requirement and post-operative pain scores were recorded and compared.Results:Operative time and intra-operative blood loss were both significantly less for the guillotine technique (p < 0.001) and there was a significantly reduced haemostasis requirement (p < 0.001). Pain was also less on the guillotine side (p < 0.001). There were no tonsillar remnants or palatal trauma for either technique. There was no significant difference between techniques in the frequency of secondary haemorrhage.Conclusion:This study provides level Ib evidence that guillotine tonsillectomy in children with mobile tonsils is an effective and time-efficient procedure which produces less intra-operative blood loss and post-operative pain than cold steel dissection.

scholarly journals What Are the Trends in Tonsillectomy Techniques in Wales? A Prospective Observational Study of 19,195 Tonsillectomies over a 10-Year Period

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Hussein Walijee ◽  
Ali Al-Hussaini ◽  
Andrew Harris ◽  
David Owens
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Surgical Instrument ◽  
Bipolar Diathermy ◽  
Intraoperative Bleeding ◽  
Surveillance Programme ◽  
National Guidance ◽  
Secondary Haemorrhage ◽  
The Uk ◽  
Cold Steel Dissection

There are a multitude of techniques to undertake tonsillectomy, with hot techniques such as diathermy and coblation being associated with a higher risk of secondary haemorrhage. The UK National Prospective Tonsillectomy Audit (2004) advocated cold steel dissection and ties to be the gold standard. This prospective observational study investigates the trends in tonsillectomy techniques across Wales in the last decade to establish if surgeons have adhered to this national guidance. Data relating to tonsillectomy were extracted over a 10-year period from 1 January 2003 to 31 December 2012 from the Wales Surgical Instrument Surveillance Programme database. A total of 19,195 patients were included. Time-series analysis using linear regression showed there was an increase in the number of bipolar diathermy tonsillectomies by 84% (Pearson’sr=0.762,p=0.010) and coblation tonsillectomies by 120% (r=0.825,p=0.003). In contrast, there was a fall in the number of cold steel dissection tonsillectomies with ties by 60% (r=-0.939,p<0.001). This observational study suggests that the use of bipolar and coblation techniques for tonsillectomy has increased. This deviation from national guidance may be due to these techniques being faster with less intraoperative bleeding. Further study for the underlying reasons for the increase in these techniques is warranted.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

scholarly journals SMILE and Wavefront-Guided LASIK Out-Compete Other Refractive Surgeries in Ameliorating the Induction of High-Order Aberrations in Anterior Corneal Surface

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Min-jie Ye ◽  
Cai-yuan Liu ◽  
Rong-feng Liao ◽  
Zheng-yu Gu ◽  
Bing-ying Zhao ◽  
...  
Keyword(s):  
Spherical Aberration ◽  
Laser In Situ Keratomileusis ◽  
Small Incision Lenticule Extraction ◽  
Corneal Surface ◽  
Small Incision ◽  
Significant Difference ◽  
Lenticule Extraction ◽  
A Prospective Study ◽  
High Order Aberrations

Purpose. To compare the change of anterior corneal higher-order aberrations (HOAs) after laser in situ keratomileusis (LASIK), wavefront-guided LASIK with iris registration (WF-LASIK), femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK), and small incision lenticule extraction (SMILE).Methods. In a prospective study, 82 eyes underwent LASIK, 119 eyes underwent WF-LASIK, 88 eyes underwent FS-LASIK, and 170 eyes underwent SMILE surgery. HOAs were measured with Pentacam device preoperatively and 6 months after surgery. The aberrations were described as Zernike polynomials, and analysis focused on total HOAs, spherical aberration (SA), horizontal coma, and vertical coma over 6 mm diameter central corneal zone.Results. Six months postoperatively, all procedures result in increase of anterior corneal total HOAs and SA. There were no significant differences in the induced HOAs between LASIK and FS-LASIK, while SMILE induced fewer total HOAs and SA compared with LASIK and FS-LASIK. Similarly, WF-LASIK also induced less total HOAs than LASIK and FS-LASIK, but only fewer SA than FS-LASIK (P<0.05). No significant difference could be detected in the induced total HOAs and SA between SMILE and WF-LASIK, whereas SMILE induced more horizontal coma and vertical coma compared with WF-LASIK (P<0.05).Conclusion. FS-LASIK and LASIK induced comparable anterior corneal HOAs. Compared to LASIK and FS-LASIK, both SMILE and WF-LASIK showed advantages in inducing less total HOAs. In addition, SMILE also possesses better ability to reduce the induction of SA in comparison with LASIK and FS-LASIK. However, SMILE induced more horizontal coma and vertical coma compared with WF-LASIK, indicating that the centration of SMILE procedure is probably less precise than WF-LASIK.

Impact of Treatment on Vestibular Schwannoma–Associated Symptoms: A Prospective Study Comparing Treatment Modalities

2021 ◽  
pp. 019459982098656
Author(s):  
Jason H. Barnes ◽  
Neil S. Patel ◽  
Christine M. Lohse ◽  
Nicole M. Tombers ◽  
Michael J. Link ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Median Number ◽  
Treatment Modalities ◽  
Baseline Survey ◽  
Limited Attention ◽  
Subjective Symptoms ◽  
Prospective Survey ◽  
Significant Difference ◽  
Associated Symptoms ◽  
A Prospective Study

Objective The degree to which various treatment modalities modify vestibular schwannoma (VS)–associated symptoms has received limited attention. The purpose of this study was to determine how different treatment modalities affect subjective symptoms in those presenting with VS. Study Design Prospective survey. Setting Tertiary neurotology referral center. Methods Patients with sporadic VS who received treatment at our institution were prospectively surveyed with a VS symptom questionnaire. Those who completed a baseline survey prior to treatment and at least 1 posttreatment survey were included. The prospective survey evaluated the severity of self-reported symptoms (Likert scale, 1-10), including tinnitus, dizziness or imbalance, headaches, and hearing loss. Results A total of 244 patients were included (mean age, 57 years). The mean duration of follow-up was 2.1 years, and the median number of surveys completed was 2 (interquartile range, 1-3). Seventy-eight (32%) cases were managed with observation, 118 (48%) with microsurgery, and 48 (20%) with radiosurgery. Multivariable analyses revealed no statistically significant difference in the change in tinnitus ( P = .15), dizziness or imbalance ( P = 0.66), or headaches ( P = .24) among treatment groups. Evaluation of clinically important differences demonstrated that microsurgery leads to significant bidirectional changes in headaches. Conclusions Limited prospective data exist regarding the progression or resolution of subjective symptoms in those presenting with VS. This study suggests that tinnitus, dizziness or imbalance, and headaches are unlikely to be significantly modified by treatment modality and generally should not be used to direct treatment choice.

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