HEARING PRESERVATION AFTER INTRACANALICULAR VESTIBULAR SCHWANNOMA RADIOSURGERY

Neurosurgery ◽  
2008 ◽  
Vol 63 (6) ◽  
pp. 1054-1063 ◽  
Author(s):  
Ajay Niranjan ◽  
David Mathieu ◽  
John C. Flickinger ◽  
Douglas Kondziolka ◽  
L. Dade Lunsford
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Vestibular Schwannoma ◽  
Tumor Resection ◽  
Hearing Preservation ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Tumor Control ◽  
Gamma Knife Stereotactic Radiosurgery

Abstract OBJECTIVE Tumor control, facial function preservation, and hearing preservation are important criteria for successful management of intracanalicular vestibular schwannomas, whether observation, microsurgery, or radiosurgery is chosen. We collected data prospectively to assess hearing preservation after intracanalicular vestibular schwannoma radiosurgery. METHODS Between 1987 and 2003, 96 patients (65 men and 31 women) underwent gamma knife stereotactic radiosurgery (SRS) for intracanalicular tumors. The median patient age was 54 years (range, 22–80 years). Hearing was graded using the Gardner-Robertson (GR) and the American Academy of Otolaryngology–Head and Neck Surgery classifications. Dose planning was performed on intraoperative stereotactic images using multiple 4-mm isocenters. The median tumor volume was 0.112 mm3 (range, 0.05–0.447 mm3), and the median margin dose was 13 Gy (range, 10–18 Gy). RESULTS The mean and median audiologic follow-up periods were 42 months and 28 months (range, 12–144 months), respectively. Serviceable hearing was preserved in 31 of 40 (77.5%) patients with initial American Academy of Otolaryngology–Head and Neck Surgery Class A hearing. Serviceable hearing was preserved in 40 of 79 (64.5%) patients with GR Grade I or II pre-SRS hearing. Ninety-two patients had GR Grade I, II, or III hearing before SRS, and GR Grade I, II, or III hearing was maintained in 78 patients (85%). Hearing grades improved in 7 patients. Facial and trigeminal nerve function was preserved in all patients. The tumor control rate (freedom from additional intervention) was 99.0% (95 of 96) at a median follow-up of 28 months (range, 12–144 months). One patient underwent tumor resection 18 months after radiosurgery. CONCLUSION SRS is a minimally invasive first-line management option for patients with intracanalicular tumors and provides high rates of hearing preservation with minimal morbidity.

The Effect of Prescription Isodose Variation on Tumor Control and Toxicities in Stereotactic Radiosurgery for Sporadic Vestibular Schwannoma: Propensity Score-Matched Case–Control Study

2021 ◽  
Author(s):  
Achiraya Teyateeti ◽  
Christopher S. Graffeo ◽  
Avital Perry ◽  
Eric J. Tryggestad ◽  
Paul D. Brown ◽  
...  
Keyword(s):  
Propensity Score ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Tumor Control ◽  
Gamma Knife Stereotactic Radiosurgery ◽  
The Impact ◽  
Prescription Isodose

Abstract Objective Vestibular schwannoma (VS) treated with Gamma Knife stereotactic radiosurgery (SRS) was typically performed at 50% isodose line (IDL50); however, the impact of IDL variation on outcomes is poorly understood. This study aimed to compare tumor control (TC) and toxicities between treatment at 40% (IDL40) and 50% (IDL50). Methods and Materials Sporadic/unilateral VS patients treated with SRS dose 12 to 14 Gy and prescription isodose volume ≤10cm3 were included. Propensity score matching was applied to IDL40 cohort to generate an IDL50 companion cohort, adjusting for age and prescription isodose volume. After exclusion of patients with follow-up <24 months, there were 30 and 28 patients in IDL40 and IDL50 cohorts, respectively. Results Median follow-up time was 96 months (24–225 months). Actuarial and radiographic TC rates were 91.8% and clinical TC was 96.2% both at 5 and 10 years. TC was higher in IDL40 cohort but not significant (96.4 vs. 86.7%; p = 0.243). Hearing preservation (HP) rates were 71.9 and 39.2% at 5- and 10-year intervals, with significantly higher rates of HP noted in IDL40 cohort (83.3 vs. 57.1% at 5-year interval; 62.5 vs. 11.4% at 10-year interval; p = 0.017). Permanent facial neuropathy occurred in two patients, both from the IDL50 cohort (3.5%). Rates of post-SRS steroid treatment or shunt placement for hydrocephalus were slightly higher in IDL50 patients (6.9 vs. 17.9%; p = 0.208 and 3.3 vs. 7.1%; p = 0.532). Conclusion For treatment of VS with SRS, dose prescription at IDL40 or IDL50 provides excellent long-term TC and toxicity profiles. IDL40 may be associated with improved long-term HP.

Postsurgical Follow-Up of Children with Tympanostomy Tubes: Results of the American Academy of Otolaryngology-Head and Neck Surgery Pediatric Otolaryngology Committee National Survey

2000 ◽  
Vol 122 (3) ◽  
pp. 313-318 ◽  
Author(s):  
Craig S. Derkay ◽  
Jeffrey D. Carron ◽  
Brian J. Wiatrak ◽  
Sukgi S. Choi ◽  
Jacqueline E. Jones
Keyword(s):  
Primary Care ◽  
American Academy ◽  
Head And Neck ◽  
Neck Surgery ◽  
Primary Care Providers ◽  
Head And Neck Surgery ◽  
Care Providers ◽  
Pediatric Otolaryngology ◽  
Tympanostomy Tubes

Postsurgical follow-up of children with tympanostomy tubes is becoming a contentious issue in this era of managed care. Primary care providers believe themselves to be capable of evaluating these children. Otolaryngologists, on the other hand, have more specialized equipment available to them (suction apparatus, otomicroscopes, audiology devices, etc) for treating suppurative infections and monitoring the tympanic membrane for structural changes. In addition, the otolaryngologist is placed in an uncomfortable legal and ethical position if access to the patient with a tube-related complication is denied by the primary care provider. Attempts to develop an American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) policy statement have been hampered by a lack of data on the incidence and severity of tube-related complications and the role that otolaryngologists can play in reducing these sequelae. A survey designed by the AAO-HNS Pediatric Otolaryngology Committee was distributed to 1000 board-certified otolaryngologists and all members of the American Society of Pediatric Otolaryngologists and the American Academy of Pediatrics-Otolaryngology Section regarding current practice patterns and practitioners' experiences with tympanostomy tube complications. Specific information regarding complications that could have been avoided with earlier otolaryngology referral was also obtained. The results of the survey and its implications for AAO-HNS policy are presented.

Postsurgical follow-up of children with tympanostomy tubes: Results of the American Academy of Otolaryngology–Head and Neck Surgery Pediatric Otolaryngology Committee National Survey

2000 ◽  
Vol 122 (3) ◽  
pp. 313-318
Author(s):  
Craig S. Derkay ◽  
Jeffrey D. Carron ◽  
Brian J. Wiatrak ◽  
Sukgi S. Choi ◽  
Jacqueline E. Jones
Keyword(s):  
Primary Care ◽  
American Academy ◽  
Head And Neck ◽  
Neck Surgery ◽  
Primary Care Providers ◽  
Head And Neck Surgery ◽  
Care Providers ◽  
Pediatric Otolaryngology ◽  
Tympanostomy Tubes

Postsurgical follow-up of children with tympanostomy tubes is becoming a contentious issue in this era of managed care. Primary care providers believe themselves to be capable of evaluating these children. Otolaryngologists, on the other hand, have more specialized equipment available to them (suction apparatus, otomicroscopes, audiology devices, etc) for treating suppurative infections and monitoring the tympanic membrane for structural changes. In addition, the otolaryngologist is placed in an uncomfortable legal and ethical position if access to the patient with a tube-related complication is denied by the primary care provider. Attempts to develop an American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) policy statement have been hampered by a lack of data on the incidence and severity of tube-related complications and the role that otolaryngologists can play in reducing these sequelae. A survey designed by the AAO-HNS Pediatric Otolaryngology Committee was distributed to 1000 board-certified otolaryngologists and all members of the American Society of Pediatric Otolaryngologists and the American Academy of Pediatrics–Otolaryngology Section regarding current practice patterns and practitioners' experiences with tympanostomy tube complications. Specific information regarding complications that could have been avoided with earlier otolaryngology referral was also obtained. The results of the survey and its implications for AAO-HNS policy are presented.

American Academy of Otolaryngology–Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities

2021 ◽  
pp. 019459982098413
Author(s):  
Cecelia E. Schmalbach ◽  
Jean Brereton ◽  
Cathlin Bowman ◽  
James C. Denneny
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Best Practice ◽  
Medical Center ◽  
Quality Care ◽  
Academic Medical Center ◽  
Neck Surgery ◽  
Performance Measure ◽  
Head And Neck Surgery ◽  
Evidence Based

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

Tonsillektomia w populacji pediatrycznej – główne wskazania, aktualne wytyczne Amerykańskiej Akademii Otolaryngologów Chirurgów Głowy i Szyi

2019 ◽  
Vol 23 (4) ◽  
Author(s):  
Anna Wierzbicka-Rot ◽  
Artur Gadomski
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Postoperative Care ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Evidence Based ◽  
Practical Information

In February 2019 American Academy of Otolaryngology-Head and Neck Surgery published clinical practice guidelines which provides evidence-based recommendations that applies to children under consideration for tonsillectomy. This update to the 2011 publication includes large amount of new, practical information about pre-, intra- and postoperative care and management, that can be useful for surgeons as well as GPs and pediatricians

Is GRADE the Right Choice for Clinical Practice Guidelines Developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation?

2019 ◽  
Vol 161 (1) ◽  
pp. 3-5
Author(s):  
Andrés M. Bur ◽  
Richard M. Rosenfeld
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Current Knowledge ◽  
Clinical Care ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
The Right

Clinical practice guidelines (CPGs), developed to inform clinicians, patients, and policy makers about what constitutes optimal clinical care, are one way of increasing implementation of evidence into clinical practice. Many factors must be considered by multidisciplinary guideline panels, including strength of available evidence, limitations of current knowledge, risks/benefits of interventions, patient values, and limited resources. Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a framework for summarizing evidence that has been endorsed by many national and international organizations for developing CPGs. But is GRADE the right choice for CPGs developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF)? In this commentary, we will introduce GRADE, discuss its strengths and limitations, and address the question of what potential benefits GRADE might offer beyond existing methodology used by the AAO-HNSF in developing CPGs.

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