Hearing outcomes of vestibular schwannoma patients managed with ‘wait and scan’: predictive value of hearing level at diagnosis

2010 ◽  
Vol 124 (5) ◽  
pp. 490-494 ◽  
Author(s):  
S-E Stangerup ◽  
M Tos ◽  
J Thomsen ◽  
P Caye-Thomasen
Keyword(s):  
Vestibular Schwannoma ◽  
Predictive Value ◽  
High Frequency ◽  
Pure Tone ◽  
Hearing Level ◽  
Speech Discrimination ◽  
Resonance Imaging ◽  
Hearing Outcome ◽  
Hearing Outcomes ◽  
Better Than

AbstractAims:This study aimed to evaluate the predictive value of both hearing level (at various frequencies) and speech discrimination for forecasting hearing outcome after a period of observation, in patients with vestibular schwannoma.Subjects:Over a 33-year period, 1144 patients with vestibular schwannoma were allocated to ‘wait and scan’ management, with annual magnetic resonance imaging and audiological examination. Two complete pure tone and speech discrimination audiograms were available for 932 patients.Results:The predictive value of initial hearing level better than 10 dB for forecasting hearing outcome after observation increased from 59 per cent at 250 Hz to 94 percent at 4000 Hz. At diagnosis, hearing level of 10 dB or better at 4000 Hz was found in only 18 of the 932 VS ears, while good speech discrimination was found in 159 patients (17 per cent). Of the latter patients, 138 maintained good hearing after observation.Conclusion:In vestibular schwannoma patients, good high frequency hearing and good speech discrimination at diagnosis are useful tools in predicting good hearing after observation.

scholarly journals Characteristics of Presbycusis in A Super-Aged Society

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Hajime Sano
Keyword(s):  
Hearing Loss ◽  
High Frequency ◽  
Pure Tone ◽  
The Elderly ◽  
Elderly Group ◽  
Hearing Level ◽  
Speech Discrimination ◽  
Frequency Range ◽  
Female Patients ◽  
Male Patients

Objectives: To estimate presbycusis' characteristics and investigate whether any changes have occurred in the pathophysiology of presbycusis over the decades. Methods: This was a retrospective cross-sectional observational study. A total of 186 patients aged ≥ 65 years were selected for the elderly group; they included patients with mild-to-moderate sensorineural hearing loss of unknown cause. For the middle age group, 56 patients aged 30–50 years who had positive results for the recruitment phenomenon were selected as controls. The participants’ age, sex, pure-tone hearing levels of air conduction (125–8000 Hz), maximum speech discrimination score (SDSmax), and the presence or absence of the recruitment phenomenon were investigated based on medical records. Results: Sixty-one patients in the elderly group were aged ≥ 80 years. Hearing levels were significantly better in male patients in the low-frequency range and significantly better in female patients in the high-frequency range (p < 0.01). In the elderly group, the proportion of patients with poor speech discrimination was 52.4–70.2%. The SDSmax was significantly higher in female patients than in male patients (p < 0.01). The proportion of patients with the recruitment phenomenon was 93.5%. The audiometric hearing pattern was dominated by a gradual-down slope, high-frequency-impaired, and flat patterns. There were significantly more female patients with a flat pattern and significantly more male patients with a gradual-downslope pattern and U-shaped pattern (p < 0.01). Age, sex, mean pure-tone hearing level, and audiometric hearing pattern significantly affected the SDSmax (all, p < 0.05), as evaluated with multiple regression analysis. Conclusion: More than half of the elderly patients with mild or moderate hearing loss were estimated to have retrocochlear damage. The age of hospital visitors for presbycusis was found to have increased over time. However, the distribution of pathophysiologies was not different from that in previous studies performed with relatively younger patients. This suggests a shift of patients presenting with presbycusis toward an older age range.

Significance of Cochlear Dose in the Radiosurgical Treatment of Vestibular Schwannoma

Neurosurgery ◽  
2014 ◽  
Vol 74 (5) ◽  
pp. 466-474 ◽  
Author(s):  
Jeffrey T. Jacob ◽  
Matthew L. Carlson ◽  
Terry K. Schiefer ◽  
Bruce E. Pollock ◽  
Colin L. Driscoll ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vestibular Schwannoma ◽  
Pure Tone ◽  
Interobserver Reliability ◽  
Univariate Analysis ◽  
Hearing Preservation ◽  
Neck Surgery ◽  
Tumor Control ◽  
Speech Discrimination ◽  
Pure Tone Average

Abstract BACKGROUND: Cochlear dose has been identified as a potentially modifiable contributor to hearing loss after stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). OBJECTIVE: To evaluate the association between computed tomography-based volumetric cochlear dose and loss of serviceable hearing after SRS, to assess intraobserver and interobserver reliability when determining modiolar point dose with the use of magnetic resonance imaging and computed tomography, and to discuss the clinical significance of the cochlear dose with regard to radiosurgical planning strategy. METHODS: Patients with serviceable pretreatment hearing who underwent SRS for sporadic VS between the use of Gamma Knife Perfexion were studied. Univariate and multivariate associations with the primary outcome of time to nonserviceable hearing were evaluated. RESULTS: A total of 105 patients underwent SRS for VS during the study period, and 59 (56%) met study criteria and were analyzed. Twenty-one subjects (36%) developed nonserviceable hearing at a mean of 2.2 years after SRS (SD, 1.0 years; median, 2.1 years; range 0.6-3.8 years). On univariate analysis, pretreatment pure tone average, speech discrimination score, American Academy of Otolaryngology-Head and Neck Surgery hearing class, marginal dose, and mean dose to the cochlear volume were statistically significantly associated with time to nonserviceable hearing. However, after adjustment for baseline differences, only pretreatment pure tone average was statistically significantly associated with time to nonserviceable hearing in a multivariable model. CONCLUSION: Cochlear dose is one of many variables associated with hearing preservation after SRS for VS. Until further studies demonstrate durable tumor arrest with reduced dose protocols, routine tumor dose planning should not be modified to limit cochlear dose at the expense of tumor control.

scholarly journals Audiometric Characteristics of Presbycusis: A Hospital-Based Study

2021 ◽  
Vol 10 (3) ◽  
pp. 169-175
Author(s):  
Ghulam Saqulain ◽  
Gul Zahra ◽  
Nazia Mumtaz
Keyword(s):  
Hearing Loss ◽  
High Frequency ◽  
Pure Tone ◽  
Noise Exposure ◽  
Pure Tone Audiometry ◽  
Sampling Technique ◽  
Rehabilitation Medicine ◽  
Speech Discrimination ◽  
Chi Square ◽  
Severe Hearing Loss

Background: Presbycusis is related to degenerative changes of aging resulting from deficient cochlear microcirculation. It is characterized by bilateral, symmetrical, sensorineural hearing loss (SNHL) in which recruitment and speech discrimination is affected in the absence of noise exposure. The objective of this study was to analyze the pure tone audiogram characteristics in Presbycusis. Methods: This descriptive study recruited n=192 cases of presbycusis of both genders, aged 50 to 80 years with convenience sampling technique. The study was conducted at Yusra General Hospital and the National Institute of Rehabilitation Medicine, Islamabad from1st July 2017 to 30th September 2017. Pure tone audiometry was used to collect audiometric data. SPSS-24 was used for data analysis. Chi-square and Pearson’s correlation were used to determine association between variables with p < 0.05 taken as significant. Results: Pure tone audiometry revealed 58 (30.2%) right and 65 (33.9%) left ears with high frequency gently sloping audiogram, while the second commonest configuration being high frequency steeply sloping curve in 51(26.6%) right and 52(27.1%) left ears. There was a significant correlation between the configuration of the audiogram and age with p=0.000, while no significant correlation with gender (p=0.71). The majority,77 (40.10%) right and 71(36.98%) of left ears had moderately severe hearing loss, while severe hearing loss was second commonest with 60(31.25%) right and 70(36.46%) left ears affected. The severity of hearing loss had a significant (P=0.000) positive correlation with age but no significant relationship with gender. Conclusion:  High frequency gently sloping audiogram was the commonest configuration followed by high frequency steeply sloping curve. Moderately severe hearing loss was most commonly seen followed by severe hearing loss.

scholarly journals Comparative study of hearing level pre and post ossiculoplasty in Aseer Central Hospital, Saudi Arabia

2018 ◽  
Vol 4 (2) ◽  
pp. 312
Author(s):  
Abdullah Assiri ◽  
Ali M. Al-Qannass ◽  
Tawfiq A. Khurayzi ◽  
Talat E. Alardi
Keyword(s):  
Saudi Arabia ◽  
Middle Ear ◽  
Male Gender ◽  
Hearing Level ◽  
Central Hospital ◽  
Hearing Improvement ◽  
Kingdom Of Saudi Arabia ◽  
Hearing Outcome ◽  
Average Change ◽  
Hearing Outcomes

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Achieving successful hearing outcomes following ossiculoplasty in patients with middle ear diseases depend on several factors. Unfortunately, the literature is confusing concerning the middle ear factors and types of pathologic process that are most important in predicting hearing outcome. The objective of the study was to investigate the improvement or deterioration of hearing after ossiculoplasty and identify the possible prognostic factors.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Between January, 2012 and December, 2014, 30 ossiculoplasties were performed and followed up by the first author with the help of other authors in Otolaryngology department, Aseer Ceneral hospital, Abha, Kingdom of Saudi Arabia. The patients were followed up at 6 months, 9 months after the operation and then on a yearly basis. Postoperative hearing outcomes were considered successful if the postoperative air-bone gap was within 20 dB while it was considered not successful if it exceeds 20 dB.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The study included 30patients. Their age ranged between 18 and 61 years with a mean of 37.4±10.7 years. Sixty percent of them (n=18) were females and forty percent (n=12) were males. Pre-operative PTA was 37.83±8.97 dB and it decreased to 23.0±12.57 dB postoperatively. This difference was statistically significant (p&lt;0.001) with an average change in ABG of 150 dB across the 30 patients. The successful rate was 50%. the only factor proved to be significantly associated with successful ossiculoplasty was the male gender as 75% of makes compared to 33.3% of females patients reported postoperative air-bone gap within 20 dB, p=0.030. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Successful rate of ossiculoplasty in Asser central hospital is within the globally reported rates. However, further larger prospective study is recommended for better understanding of predictive factors for hearing improvement after ossiculoplasty that may contribute to the surgeon’s judgment and the information given to patients.</span></p>

Stapes fixation surgery: stapedectomy versus stapedotomy

2010 ◽  
Vol 4 (3) ◽  
pp. 429-434 ◽  
Author(s):  
Taweekiat Thamjarayakul ◽  
Pakpoom Supiyaphun ◽  
Kornkiat Snidvongs
Keyword(s):  
Success Rate ◽  
Pure Tone ◽  
Bone Conduction ◽  
Surgical Techniques ◽  
Speech Discrimination ◽  
Stapes Fixation ◽  
Pure Tone Average ◽  
Window Opening ◽  
Hearing Outcomes ◽  
Air Conduction

Abstract Background: Stapedectomy and stapedotomy are the standard techniques for stapes fixation surgery. Both techniques depend on the size of window opening (total, partial stapedectomy and small-hole stapedotomy) and the type of prosthesis used. Outcome of technique and prosthesis are controversy. Objective: Evaluate the outcomes of the two surgical techniques (stapedectomy/stapedotomy) and two sizes of prosthesis (Cawthorn 0.6mm/0.3mm) in terms of effectiveness and safety. Material and methods: Sixty-four medical records of patients undergoing stapedectomy or stapedotomy between the year 1995 and 2005 were reviewed. The subjects were classified into three groups including 0.6-mm stapedectomy, 0.6-mm and 0.3-mm stapedotomy group. The pre and post operative air-conduction threshold (AC) and air-bone gap (A-B gap) were compared for each group. The pre-and post-operative differences in pure tone average of AC, pure tone average of bone conduction threshold (BC), AB gap, AC at 4KHz, BC at 4KHz, AC at 8KHz, and speech discrimination score (SDS) were analyzed. The surgical complications were also compared. Results: Means of post-operative AC, and A-B gap were significantly better in all three groups. The mean of postoperative AC at 4KHz was significantly improved only in stapedotomy groups (0.6-mm and 0.3-mm stapedotomy). To compare the hearing outcomes among the three groups, there were no statistically significant differences between 0.6-mm stapedectomy vs. 0.6-mm stapedotomy, and between 0.6- mm vs. 0.3-mm stapedotomy. The complications were found in all three groups. The 0.3-mm stapedotomy had the lowest rate. Conclusion: Stapedectomy versus stapedotomy yields comparable hearing outcomes but stapedotomy results had a better success rate than the stapedectomy. For 0.6-mm stapedotomy vs. 0.3-mm stapedotomy, the overall results in both groups are not significantly different, in terms of both the hearing outcomes and the success rate. In terms of complication rate, 0.6-mm stapedectomy had the highest rate, while 0.3-mm stapedotomy had the lowest.

Hearing preservation in surgery for large vestibular schwannomas

2009 ◽  
Vol 111 (4) ◽  
pp. 845-854 ◽  
Author(s):  
Masahiko Wanibuchi ◽  
Takanori Fukushima ◽  
John T. McElveen ◽  
Allan H. Friedman
Keyword(s):  
Pure Tone ◽  
Hearing Preservation ◽  
Hearing Level ◽  
Discrimination Score ◽  
Speech Discrimination ◽  
Pure Tone Average ◽  
Speech Discrimination Score ◽  
Class A ◽  
Abducent Nerve Palsy ◽  
Hearing Preservation Surgery

Object Hearing preservation remains a challenging problem in vestibular schwannoma (VS) surgery. The ability to preserve hearing in patients with large tumors is subject to particular difficulty. In this study, the authors focus on hearing preservation in patients harboring large VSs. Methods A total of 344 consecutive patients underwent surgical removal of VSs over the past 9 years. Of these 344 cases, 195 VSs were > 20 mm in maximum cisternal diameter. Of the 195 cases, hearing preservation surgery was attempted for 54 patients who had a Class A, B, C, or D preoperative hearing level; that is, a pure tone average ≤ 60 dB and speech discrimination score ≥ 50% according to the Sanna/Fukushima classification. The tumors were classified as moderately large (21–30 mm based on the largest extrameatal diameter), large (31–40 mm), and giant (≥ 41 mm) according to the international criteria. The authors categorized patients with Class A, B, C, D, or E hearing (pure tone average ≤ 80 dB and speech discrimination score ≥ 40%) as having preserved hearing postoperatively. Results Forty-one tumors (75.9%) were totally removed and 13 (24.1%) had near-total removal. Of the 54 patients, 29 maintained their hearing postoperatively; the overall hearing preservation rate was 53.7%. Analysis based on the preoperative hearing level showed that hearing was preserved in 14 (77.8%) of 18 cases for Class A; in 8 (47.1%) of 17 cases for Class B; in 4 (57.1%) of 7 cases for Class C; and in 3 (25.0%) of 12 cases for Class D. In addition, according to the analysis based on the tumor size, 20 (52.6%) of 38 patients with moderately large tumors retained their hearing, as did 5 (50.0%) of 10 patients with large tumors and 4 (66.7%) of 6 patients with giant tumors. Complications included 2 cases of bacterial meningitis that were cured by intravenous injection of antibiotics, 3 cases of subcutaneous CSF leakage that resolved without any surgical repair, and 1 case of temporary abducent nerve palsy. There were no deaths in this series. Conclusions The results indicate that successful hearing preservation surgery in large VSs is possible with meticulous technique and attention to adhesions between the tumor and the cochlear nerves.

scholarly journals Hearing subclassification may predict long-term auditory outcomes after radiosurgery for vestibular schwannoma patients with good hearing

2016 ◽  
Vol 125 (4) ◽  
pp. 845-852 ◽  
Author(s):  
Seyed H. Mousavi ◽  
Ajay Niranjan ◽  
Berkcan Akpinar ◽  
Marshall Huang ◽  
Hideyuki Kano ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Pure Tone ◽  
Hearing Preservation ◽  
Class I ◽  
Tumor Control ◽  
Speech Discrimination ◽  
Pure Tone Average

OBJECTIVE In the era of MRI, vestibular schwannomas are often recognized when patients still have excellent hearing. Besides success in tumor control rate, hearing preservation is a main goal in any procedure for management of this population. The authors evaluated whether modified auditory subclassification prior to radiosurgery could predict long-term hearing outcome in this population. METHODS The authors reviewed a quality assessment registry that included the records of 1134 vestibular schwannoma patients who had undergone stereotactic radiosurgery during a 15-year period (1997–2011). The authors identified 166 patients who had Gardner-Robertson Class I hearing prior to stereotactic radiosurgery. Fifty-three patients were classified as having Class I-A (no subjective hearing loss) and 113 patients as Class I-B (subjective hearing loss). Class I-B patients were further stratified into Class I-B1 (pure tone average ≤ 10 dB in comparison with the contralateral ear; 56 patients), and I-B2 (> 10 dB compared with the normal ear; 57 patients). At a median follow-up of 65 months, the authors evaluated patients' hearing outcomes and tumor control. RESULTS The median pure tone average elevations after stereotactic radiosurgery were 5 dB, 13.5 dB, and 28 dB in Classes I-A, I-B1, and I-B2, respectively. The median declines in speech discrimination scores after stereotactic radiosurgery were 0% for Class I-A (p = 0.33), 8% for Class I-B1 (p < 0.0001), and 40% for Class I-B2 (p < 0.0001). Serviceable hearing preservation rates were 98%, 73%, and 33% for Classes I-A, I-B1, and I-B2, respectively. Gardner-Robertson Class I hearing was preserved in 87%, 43%, and 5% of patients in Classes I-A, I-B1, and I-B2, respectively. CONCLUSIONS Long-term hearing preservation was significantly better if radiosurgery was performed prior to subjective hearing loss. In patients with subjective hearing loss, the difference in pure tone average between the affected ear and the unaffected ear was an important factor in long-term hearing preservation.

A Spondee Recognition Test for Young Hearing-Impaired Children

1974 ◽  
Vol 39 (3) ◽  
pp. 304-311 ◽  
Author(s):  
Kathryn D. Cramer ◽  
Norman P. Erber
Keyword(s):  
Recognition Test ◽  
Pure Tone ◽  
Close Relation ◽  
Hearing Impaired ◽  
Hearing Level ◽  
Repeated Testing ◽  
Stable Performance ◽  
Impaired Children ◽  
Better Than ◽  
Hearing Impaired Children

Ten spondaic words recorded on Language Master cards were presented monaurally, through insert receivers, to 58 hearing-impaired children to evaluate their ability to recognize familiar speech material. The subjects ranged in age from five to nine years, and their average pure-tone thresholds (500-1000-2000 Hz) ranged in hearing level from 52 to 123 dB (ANSI, 1969). The children were tested individually, on consecutive days, until their performance stabilized—which required from four to 10 sessions. They indicated their responses by pointing to labeled picture cards. Spondee recognition scores were bimodally distributed, with clusters of scores of 0–65% and 66–100%, respectively. In general, pure-tone averages better than 93 dB HTL were associated with spondee scores from 66 to 100%, while pure-tone averages poorer than 103 dB HTL corresponded to spondee scores from 0 to 65%. However, no close relation between pure-tone thresholds and spondee recognition scores was found for average hearing levels between 93 and 103 dB. Recognition scores varied as a function of repeated testing in three general ways: stable performance, steadily improving performance, or inconsistent performance.

Change in hearing during ‘wait and scan’ management of patients with vestibular schwannoma

2007 ◽  
Vol 122 (7) ◽  
pp. 673-681 ◽  
Author(s):  
S-E Stangerup ◽  
P Caye-Thomasen ◽  
M Tos ◽  
J Thomsen
Keyword(s):  
Vestibular Schwannoma ◽  
Tumour Growth ◽  
Hearing Preservation ◽  
Speech Discrimination ◽  
Hearing Results ◽  
Small Tumour ◽  
Magnetic Resonance Scanning ◽  
Normal Speech ◽  
Better Than ◽  
Observation Period

AbstractAim:To evaluate hearing changes during ‘wait and scan’ management of patients with vestibular schwannoma.Subjects:Over a 10-year period, 636 patients have prospectively been allocated to ‘wait and scan’ management, with annual magnetic resonance scanning and audiological examination.Results:At the time of diagnosis, 334 patients (53 per cent) had good hearing and speech discrimination of better than 70 per cent; at the end of the 10-year observation period, this latter percentage was 31 per cent. In 17 per cent of the patients, speech discrimination at diagnosis was 100 per cent; of these, 88 per cent still had good hearing at the end of the observation period. However, in patients with even a small initial speech discrimination loss, only 55 per cent maintained good hearing at the end of the observation period.Conclusion:After comparing the hearing results of hearing preservation surgery and of radiation therapy with those of ‘wait and scan’ management, it appears that, in vestibular schwannoma patients with a small tumour and normal speech discrimination, the main indication for active treatment should be established tumour growth.

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