Brainstem Auditory Evoked Potential Monitoring during Microvascular Decompression for Hemifacial Spasm: Intraoperative Brainstem Auditory Evoked Potential Changes and Warning Values to Prevent Hearing Loss—Prospective Study in a Consecutive Series of 84 Patients

Neurosurgery ◽  
2004 ◽  
Vol 54 (1) ◽  
pp. 97-106 ◽  
Author(s):  
Gustavo Polo ◽  
Catherine Fischer ◽  
Marc P. Sindou ◽  
Vincent Marneffe
Keyword(s):  
Hearing Loss ◽  
Hearing Impairment ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Pure Tone ◽  
Auditory Evoked Potential ◽  
Pure Tone Average ◽  
Group 3 ◽  
The Mean ◽  
Group 2

Abstract OBJECTIVE The nerve function of Cranial Nerve VIII is at risk during microvascular decompression for hemifacial spasm. Intraoperative monitoring of brainstem auditory evoked potentials (BAEPs) can be a useful tool to decrease the danger of hearing loss. The aim of this study was 1) to assess the side effects of surgery on hearing and describe the main intraoperative BAEP changes observed in the authors' series, and 2) to define warning values beyond which the probability of hearing impairment rises significantly. These values were calculated by correlating the (possible) postoperative hearing disturbances evaluated in terms of pure tone average with intraoperative BAEP changes (especially delay in Wave V latency). METHODS This series included 84 consecutive patients affected with hemifacial spasm who underwent microvascular decompression during which BAEPs were monitored. During surgery, Wave I, I to V interpeak interval, latency, and amplitude of Wave V were recorded and measured. Auditory function was studied before and after surgery and expressed as a pure tone average in all patients. Then, correlations were made between hearing impairment after surgery and intraoperative BAEP changes in an attempt to define warning values. RESULTS Seventy-four patients (88%) had no hearing loss after surgery (Group 1). Eight patients (9.5%) had hearing impairment with a decrease in pure tone average of more than 20 dB (Group 2). Two patients (2.3%) experienced a definitive and complete hearing loss on the side operated on (Group 3). Among intraoperative BAEP changes, latency of Peak V was the most frequently observed and the most significant phenomenon, especially during cerebellar retraction and the decompression step of the microvascular decompression procedure. In the group of patients without hearing loss (Group 1), the mean delay in latency of Peak V was 0.61 millisecond (standard deviation, ±0.36 ms); in the group with hearing decrease (Group 2), the mean delay was 1.05 milliseconds (standard deviation, ±0.64 ms); and in the group with deafness (Group 3), Wave V was abolished. CONCLUSION From a practical standpoint, three warning values, based on delay in latency of Peak V, were established for use during surgery: an initial one at 0.4 millisecond (“watching” signal) at the safety limit; a second one at 0.6 millisecond (risk “warning” signal), which is the mean value corresponding to the group of patients without postoperative hearing loss; and an ultimate one at 1 millisecond (“critical” warning), before irreversibility. These warnings should help the surgeon to avoid or correct maneuvers that are dangerous for hearing function, which is mandatory in functional surgery.

Modification of auditory pathway functions in patients with hearing improvement after middle ear surgery

1998 ◽  
Vol 119 (1) ◽  
pp. 125-130 ◽  
Author(s):  
Juha-Pekka Vasama ◽  
Jyrki P. Mäkelä ◽  
Hans A. Ramsay
Keyword(s):  
Hearing Loss ◽  
Middle Ear ◽  
Pure Tone ◽  
Conductive Hearing Loss ◽  
Adult Patients ◽  
Middle Ear Surgery ◽  
Ear Surgery ◽  
Pure Tone Average ◽  
The Mean ◽  
Conductive Hearing

We recorded auditory-evoked magnetic responses with a whole-scalp 122-channel neuromagnetometer from seven adult patients with unilateral conductive hearing loss before and after middle ear surgery. The stimuli were 50-msec 1-kHz tone bursts, delivered to the healthy, nonoperated ear at interstimulus intervals of 1, 2, and 4 seconds. The mean preoperative pure-tone average in the affected ear was 57 dB hearing level; the mean postoperative pure-tone average was 17 dB. The 100-msec auditory-evoked response originating in the auditory cortex peaked, on average, 7 msecs earlier after than before surgery over the hemisphere contralateral to the stimulated ear and 2 msecs earlier over the ipsilateral hemisphere. The contralateral response strengths increased by 5% after surgery; ipsilateral strengths increased by 11%. The variation of the response latency and amplitude in the patients who underwent surgery was similar to that of seven control subjects. The postoperative source locations did not differ noticeably from preoperative ones. These findings suggest that temporary unilateral conductive hearing loss in adult patients modifies the function of the auditory neural pathway. (Otolaryngol Head Neck Surg 1998;119:125-30.)

Perceived Hearing Handicap of Patients with Unilateral or Mild Hearing Loss

1997 ◽  
Vol 106 (3) ◽  
pp. 210-214 ◽  
Author(s):  
Craig W. Newman ◽  
Gerald A. Hug ◽  
Gary P. Jacobson ◽  
Sharon A. Sandridge
Keyword(s):  
Hearing Loss ◽  
Individual Differences ◽  
Hearing Impairment ◽  
Pure Tone ◽  
Hearing Level ◽  
Intersubject Variability ◽  
Pure Tone Average ◽  
Hearing Handicap ◽  
Mild Hearing Loss ◽  
The Individual

Using the Hearing Handicap Inventory for Adults (HHIA), we assessed self-perceived hearing handicap in a sample of 63 patients having either unilaterally normal hearing or a mild hearing loss (pure tone average ≤40 dB hearing level). Large intersubject variability in responses to the HHIA confirmed observations that reactions to minimal hearing impairment vary greatly among patients. The individual differences in responses highlight the importance of quantifying the perceived communication and psychosocial handicap, which cannot be determined from the audiogram alone. An item examination of responses to the HHIA revealed a number of emotional and social-situational problems encountered by patients with minimal hearing loss.

Value-based neurosurgery: the example of microvascular decompression surgery

2014 ◽  
Vol 120 (2) ◽  
pp. 462-472 ◽  
Author(s):  
Nancy McLaughlin ◽  
Farzad Buxey ◽  
Karen Chaw ◽  
Neil A. Martin
Keyword(s):  
Trigeminal Neuralgia ◽  
Outcome Measures ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Surgical Care ◽  
Decompression Surgery ◽  
The Mean ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Object Value of care is emerging as a promising framework to restructure health care, emphasizing the importance of reporting multiple outcomes that encompass the entire care episode instead of isolated outcomes specific to care points during a patient's care. The authors assessed the impact of coordinated implementation of processes across the episode of surgical care on value of neurosurgical care, using microvascular decompression (MVD) as an example. Methods This study is a retrospective review of consecutive cases involving patients with either trigeminal neuralgia or hemifacial spasm undergoing first-time MVD. Patients were divided into 2 groups: Group 1 included patients who underwent surgery between February 2008 and November 2009 and Group 2 included those who underwent surgery between January 2011 and October 2012. The authors collected data on outcome measures spanning the entire surgical episode of care according to the Outcome Measures Hierarchy. Results Forty-nine patients were included: 20 patients in Group 1 and 29 patients in Group 2. Thirty-one patients underwent MVD for trigeminal neuralgia and 18 for hemifacial spasm. A zero mortality rate and high degree of symptom resolution were achieved in both groups. Group 2 benefited from a reduction in the average total operating room time, a decrease in the mean and median postoperative length of hospital stay, a decrease in the mean length of stay on the floor, and a reduction in the rates of complications and readmissions. Conclusions Comprehensive implementation of improvement processes throughout the continuum of care resulted in improved global outcome and greater value of delivered care. Enhanced-recovery perioperative protocols and diagnosis-specific clinical pathways are two avenues built around global care delivery that can help achieve an “optimal episode of surgical care” in every case.

scholarly journals Association of Midlife Hypertension with Late-Life Hearing Loss

2019 ◽  
Vol 161 (6) ◽  
pp. 996-1003 ◽  
Author(s):  
Nicholas S. Reed ◽  
Matthew G. Huddle ◽  
Joshua Betz ◽  
Melinda C. Power ◽  
James S. Pankow ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hearing Loss ◽  
Diastolic Blood Pressure ◽  
Hearing Impairment ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Late Life ◽  
Community Dwelling ◽  
Pure Tone Average ◽  
Prospective Longitudinal

Objective To investigate the association of midlife hypertension with late-life hearing impairment. Study Design Data from the Atherosclerosis Risk in Communities study, an ongoing prospective longitudinal population-based study (baseline, 1987-1989). Setting Washington County, Maryland, research field site. Subjects and Methods Subjects included 248 community-dwelling men and women aged 67 to 89 years in 2013. Systolic blood pressure (SBP) and diastolic blood pressure were measured at each of 5 study visits from 1987-1989 to 2013. Hypertension was defined by elevated systolic or diastolic blood pressure or antihypertensive medication use. A 4-frequency (0.5-4 kHz) better-hearing ear pure tone average in decibels hearing loss (dB HL) was calculated from pure tone audiometry measured in 2013. A cutoff of 40 dB HL was used to indicate clinically significant moderate to severe hearing impairment. Hearing thresholds at 5 frequencies (0.5-8 kHz) were also considered separately. Results Forty-seven participants (19%) had hypertension at baseline (1987-1989), as opposed to 183 (74%) in 2013. The SBP association with late-life pure tone average differed by the time of measurement, with SBP measured at earlier visits associated with poorer hearing; the difference in pure tone average per 10–mm Hg SBP measured was 1.43 dB HL (95% CI, 0.32-2.53) at baseline versus −0.43 dB HL (95% CI, −1.41 to 0.55) in 2013. Baseline hypertension was associated with higher thresholds (poorer hearing) at 4 frequencies (1, 2, 4, 8 kHz). Conclusion Midlife SBP was associated with poorer hearing measured 25 years later. Further analysis into the longitudinal relationship between hypertension and hearing impairment is warranted.

scholarly journals Graft uptake and post-operative hearing outcome with type-I tympanoplasty in dry versus wet ear: a comparative study

2019 ◽  
Vol 5 (6) ◽  
pp. 1557
Author(s):  
Kulwinder Singh Sandhu ◽  
Puneet Kaur ◽  
Jagdeepak Singh ◽  
Sania Arya
Keyword(s):  
Pure Tone ◽  
Type I ◽  
Hearing Improvement ◽  
Time Of Surgery ◽  
Hearing Gain ◽  
Pure Tone Average ◽  
The Mean ◽  
Type I Tympanoplasty ◽  
Group 2 ◽  
Group 1

<p class="abstract"><strong>Background:</strong> The discharging ear presents the otologist with the dilemma of operating on it or not. This study is being undertaken to study and compare the results of type I tympanoplasty in dry ear (no ear discharge at the time of surgery) and wet ear (culture negative consistent ear discharge at the time of surgery).</p><p class="abstract"><strong>Methods:</strong> 50 patients of either sex aged between 18 to 50 years undergoing type-I tympanoplasty were included in the study on the basis of pre-determined clinical criteria. Type I tympanoplasty was performed using temporalis fascia graft by underlay technique. Post-operative data regarding graft uptake and hearing improvement was recorded in the follow up period of three months.  </p><p class="abstract"><strong>Results:</strong> The complete graft uptake was there in 88% of the patients in group 1 and 84% patients in group 2. The difference in the two groups was statistically insignificant (p&gt;0.05). The mean pre-operative pure tone average in group 1 was 30.57±7.80 dB while post-operative pure tone average was 20.68±8.22 dB with a mean hearing gain of 9.89 dB. The mean pre-operative pure tone average in group 2 was 35.21±5.98 dB while the post-operative pure tone average was 27.07±9.25 dB with a mean hearing gain of 8.12 dB. There was marked hearing improvement in both the groups post operatively (p&lt;0.001 i.e., highly significant). When hearing improvement was compared between two groups there was no significant statistical difference (p&gt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> The outcome is equally good for type 1 tympanoplasty in dry and wet ear in safe (mucosal) type of chronic suppurative otitis media with respect to graft uptake and hearing improvement.</p>

scholarly journals Analysis of interpeak latencies of brainstem auditory evoked potential waveforms during microvascular decompression of cranial nerve VII for hemifacial spasm

2013 ◽  
Vol 34 (3) ◽  
pp. E6 ◽  
Author(s):  
Parthasarathy D. Thirumala ◽  
Preethi Ilangovan ◽  
Miguel Habeych ◽  
Donald J. Crammond ◽  
Jeffrey Balzer
Keyword(s):  
Hearing Loss ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Auditory Evoked Potentials ◽  
Binary Logistic Regression ◽  
Auditory Evoked Potential ◽  
Binary Logistic Regression Analysis ◽  
Speech Discrimination ◽  
Skin Change ◽  
Class C

Object Microvascular decompression (MVD) of the facial nerve is an effective treatment for patients with hemifacial spasm. Intraoperative monitoring of brainstem auditory evoked potentials (BAEPs) during MVD can reduce the incidence of hearing loss. In this study the authors' goal was to evaluate changes in interpeak latencies (IPLs) of Waves I–V, Waves III–V, and Waves I–III of BAEP Waveforms I, III, and V during MVD and correlate them with postoperative hearing loss. To date, no such study has been performed. Hearing loss is defined as nonuseful hearing (Class C/D), which is a pure tone average of more than 50 dB and/or speech discrimination score of less than 50%. Methods The authors performed a retrospective analysis of IPLs of BAEPs in 93 patients who underwent intraoperative BAEP monitoring during MVD. Patients who did not have hearing loss were in Class A/B and those who had hearing loss were in Class C/D. Results Binary logistic regression analysis of independent IPL variables was performed. A maximum change in IPLs of Waves I–III and Waves I–V and on-skin change in IPLs of Waves I–V increases the odds of hearing loss. However, on adjusting the same variables for loss of response, change in IPLs did not increase the odds of hearing loss. Conclusions Changes in IPL measurements did not increase the odds of postoperative hearing loss. This information might be helpful in evaluating the value of IPLs as alarm criteria during MVD to prevent hearing loss.

Dead Regions in the Cochlea at 4 kHz in Elderly Adults: Relation to Absolute Threshold, Steepness of Audiogram, and Pure-Tone Average

2007 ◽  
Vol 18 (02) ◽  
pp. 097-106 ◽  
Author(s):  
Hashir Aazh ◽  
Brian C.J. Moore
Keyword(s):  
Hearing Loss ◽  
Elderly People ◽  
Pure Tone ◽  
Absolute Threshold ◽  
Elderly Adults ◽  
Pure Tone Average ◽  
Significant Difference ◽  
The Mean ◽  
Noise Test ◽  
The Absolute

The aims of this study were (1) to investigate the prevalence of dead regions (DRs) at 4 kHz in elderly people with hearing loss and (2) to determine the extent to which the presence/absence of a DR can be predicted from the absolute threshold, the slope of the audiogram, or the pure-tone average (PTA) hearing loss at 0.5, 1, and 2 kHz. DRs were assessed for 98 ears with absolute thresholds between 60 and 85 dB HL at 4 kHz using the threshold equalizing noise test. Thirty-six ears had a DR at 4 kHz. There was no statistically significant difference in the slope of the audiogram or PTA between ears with and without DRs. However, the mean absolute threshold at 4 kHz was significantly higher for the group with DRs than for the group without DRs. The prevalence of DRs exceeded 50% for hearing losses greater than 70 dB. Los propósitos de este estudio fueron (1) investigar la prevalencia de regiones muertas (DR) a 4 kHz en adultos mayores con hipoacusia y (2) determinar el grado en el que la presencia o ausencia de un DR puede predecirse a partir del umbral absoluto, de la pendiente del audiograma, o de la hipoacusia según el promedio tonal puro (PTA) a 0.5, 1 y 2 KHz. Las DR fueron evaluados en 98 oídos con umbrales absolutos entre 60 y 85 dB HL en 4 kHz, utilizando la prueba de ruido ecualizador del umbral. Treinta y seis oídos tenían un DR a 4 kHz. No existió diferencia estadísticamente significativa en la pendiente del audiograma o en el PTA entre los oídos con y sin DR. Sin embargo, el umbral absoluto medio a 4 kHz fue significativamente mayor en el grupo con DR que para el grupo sin DR. La prevalencia de DR fue mayor al 50% en hipoacusias mayores de 70 dB.

Incidence of high-frequency hearing loss after microvascular decompression for hemifacial spasm

2013 ◽  
Vol 118 (4) ◽  
pp. 719-724 ◽  
Author(s):  
Tingting Ying ◽  
Parthasarathy Thirumala ◽  
Aalap Shah ◽  
Tara Nikonow ◽  
Kelley Wichman ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
High Frequency ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Stepwise Logistic Regression ◽  
Ipsilateral Side ◽  
High Frequency Hearing Loss ◽  
Number Of Patients

Object The primary aim of this study was to evaluate the incidence and discuss the pathogenesis of high-frequency hearing loss (HFHL) after microvascular decompression (MVD) for hemifacial spasm (HFS). Methods Preoperative and postoperative audiogram data and brainstem auditory evoked potentials (BAEPs) from 94 patients who underwent MVD for HFS were analyzed. Pure tone audiometry at 0.25–2 kHz, 4 kHz, and 8 kHz was calculated for all individuals pre- and postoperatively ipsilateral and contralaterally. Intraoperative neurophysiological data were reviewed independently. An HFHL was defined as a change in pure tone audiometry of more than 10 dB at frequencies of 4 and 8 kHz. Results The incidence of HFHL was 50.00% and 25.53% ipsilateral and contralateral to the side of surgery, respectively. The incidence of HFHL adjusted for conductive and nonserviceable hearing loss was 26.6% ipsilaterally. The incidence of HFHL at 4 and 8 kHz on the ipsilateral side was 37.23% and 45.74%, respectively, and it was 10.64% and 25.53%, respectively, on the contralateral side. Maximal change in interpeak latency Waves I–V compared with baseline was the only variable significantly different between groups (p < 0.05). Sex, age, and side did not increase the risk of HFHL. Stepwise logistic regression analysis did not find any changes in intraoperative BAEPs to increase the risk of HFHL. Conclusions High-frequency hearing loss occurs in a significant number of patients following MVD surgery for HFS. Drill-induced noise and transient loss of CSF during surgery may impair hearing in the high-frequency ranges on both the ipsilateral and contralateral sides, with the ipsilateral side being more affected. Changes in intraoperative BAEPs during MVD for HFS were not useful in predicting HFHL. Follow-up studies and repeat audiological examinations may be helpful in evaluating the time course and prognosis of HFHL. Prospective studies focusing on decreasing intraoperative noise exposure, as well as auditory shielding devices, will establish causation and allow the team to intervene appropriately to decrease the risk of HFHL.

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