Diagnosis and Management of Vestibular Schwannoma: Focus on Dizziness

Vestibular schwannoma (VS) is commonly encountered in the cerebellopontine angle and benign neoplasms that arise from Schwann cells of the eighth cranial nerve, which can show not only hearing loss but also various vestibular symptoms. Dizziness is the symptom causing significantly negative effect on quality of life in patients with VS. Here, we will review the dizziness in VS.

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Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms

Journal of Neurosurgery ◽

10.3171/2016.4.jns153020 ◽

2017 ◽

Vol 126 (5) ◽

pp. 1514-1519 ◽

Cited By ~ 14

Author(s):

Madjid Samii ◽

Hussam Metwali ◽

Venelin Gerganov

Keyword(s):

Quality Of Life ◽

Vestibular Schwannoma ◽

Symptom Relief ◽

Vestibular Dysfunction ◽

Control Group ◽

Surgical Removal ◽

Asymptomatic Patients ◽

Significant Difference ◽

Vestibular Symptoms

OBJECTIVEThe aim of this study was to analyze the efficacy and risks of microsurgery via the hearing-preserving retrosigmoid approach in patients with intracanalicular vestibular schwannoma (VS) suffering from disabling vestibular symptoms, with special attention to vertigo.METHODSThis is a retrospective analysis of 19 patients with intracanalicular VS and disabling vestibular dysfunction as the main or only symptom (Group A). All of the patients reported having had disabling vertigo attacks. Subjective evaluation of the impairment of patients was performed before surgery, 3 weeks after surgery, 3 months after surgery, and 1 year after surgery, using the Dizziness Handicap Inventory (DHI). The main outcome measures were improvement in quality of life as measured using the DHI, and general and functional outcomes, in particular facial function and hearing. Patient age, preoperative tumor size, preoperative DHI score, and preservation of the nontumorous vestibular nerve were tested using a multivariate regression analysis to determine factors affecting the postoperative DHI score. The Mann-Whitney U-test was used to compare the postoperative DHI score at 3 weeks, 3 months, and 1 year after surgery with a control group of 19 randomly selected patients with intracanalicular VSs, who presented without vestibular symptoms (Group B). The occurrence of early postoperative discrete vertigo attacks was also compared between groups.RESULTSThe preoperative DHI score was ≥ 54 in all patients. All patients reported having had disabling rotational vertigo before surgery. The only significant factor to affect the DHI outcome 3 weeks and 3 months after surgery was the preoperative DHI score. The DHI outcome after 1 year was not affected by the preoperative DHI score. Compared with the control group, the DHI score at 3 weeks and 3 months after surgery was significantly worse. There was no significant difference between the groups after 1 year. Vertigo was improved in all patients and completely resolved after 1 year in 17 patients.CONCLUSIONSDisabling vestibular dysfunction that affects quality of life should be considered an indication for surgery, even in otherwise asymptomatic patients with intracanalicular VS. Surgical removal of the tumor is safe and very effective in regard to symptom relief. All patients had excellent facial nerve function within 1 year after surgery, with a very good chance of hearing preservation.

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Beyond the ABCs: Hearing Loss and Quality of Life in Vestibular Schwannoma

Mayo Clinic Proceedings ◽

10.1016/j.mayocp.2020.03.033 ◽

2020 ◽

Vol 95 (11) ◽

pp. 2420-2428

Author(s):

Maria Peris-Celda ◽

Christopher S. Graffeo ◽

Avital Perry ◽

Geffen Kleinstern ◽

Panagiotis Kerezoudis ◽

...

Keyword(s):

Quality Of Life ◽

Hearing Loss ◽

Vestibular Schwannoma

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The Impact of Tinnitus and Vertigo on Patient-Perceived Quality of Life After Cerebellopontine Angle Surgery

Neurosurgery ◽

10.1227/01.neu.0000374725.19259.ea ◽

2010 ◽

Vol 67 (3) ◽

pp. 601-610 ◽

Cited By ~ 21

Author(s):

Juergen Grauvogel ◽

Jan Kaminsky ◽

Steffen K. Rosahl

Keyword(s):

Quality Of Life ◽

Hearing Loss ◽

Facial Nerve ◽

Cerebellopontine Angle ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Classification Systems ◽

Hearing Function ◽

The Impact

Abstract BACKGROUND Quality of life (QOL) has come into focus after treatment for cerebellopontine angle (CPA) lesions. OBJECTIVE This study compared subjective (tinnitus, vertigo) and objective (hearing loss, facial palsy) results of CPA surgery with patient-perceived impairment of QOL. METHODS A retrospective analysis of a consecutive series of 48 patients operated on for either a vestibular schwannoma or a meningioma in the CPA was performed. Patient's subjective impairment of QOL by tinnitus, vertigo, hearing loss, and facial nerve palsy was assessed by a visual analog scale (VAS). Objective facial nerve and hearing function were determined using House-Brackmann and Gardner-Robertson classification systems, respectively. RESULTS The return rate of questionnaires was 64.4%, with mean follow-up time of 417.2 (± 46.4) days. Mean preoperative tinnitus score was 2.5 (± 0.5) and increased to 4.6 (± 0.7) postoperatively (P < .01). The vertigo score increased from 2.0 (± 0.3) to 5.8 (± 0.6) (P < .001). Pre- and postoperative values for hearing loss were 3.4 (± 0.6) and 5.9 (± 0.7), respectively (P < .01), and for facial nerve palsy 0.7 (± 0.4) compared with 3.1 (± 0.6) postoperatively (P < .01). House-Brackmann grade 1 or 2 was determined in 87.1% of patients before and in 80.6% after surgery. Serviceable hearing (Gardner-Robertson classes I-III) was found in 75% before and in 64.3% after surgery. CONCLUSION Preservation of facial nerve and hearing function are not the only important criteria defining QOL after CPA surgery. Tinnitus and vertigo may have a significant underestimated impact on the patient's postoperative course and QOL.

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Conservative Management of Vestibular Schwannoma—A Prospective Cohort Study: Treatment, Symptoms, and Quality of Life

Neurosurgery ◽

10.1227/neu.0b013e31823f5afa ◽

2011 ◽

Vol 70 (5) ◽

pp. 1072-1080 ◽

Cited By ~ 44

Author(s):

Cathrine Nansdal Breivik ◽

Jobin K. Varughese ◽

Tore Wentzel-Larsen ◽

Flemming Vassbotn ◽

Morten Lund-Johansen

Keyword(s):

Quality Of Life ◽

Hearing Loss ◽

Tumor Growth ◽

Vestibular Schwannoma ◽

Conservative Management ◽

Short Form ◽

Glasgow Benefit Inventory ◽

Sf 36

Abstract BACKGROUND: One hundred ninety-three patients with sporadic unilateral vestibular schwannoma given conservative management were enrolled in a prospective study. OBJECTIVE: To evaluate the efficacy of conservative management and to determine the effect of an initial conservative management on the quality of life (QOL) and severity of audio vestibular symptoms. METHODS: The patients underwent magnetic resonance imaging scans, clinical examination, and QOL assessment by 2 validated questionnaires, the Short Form-36 (SF-36) and Glasgow Benefit Inventory (GBI). Using regression analysis of clustered data, we analyzed possible associations between tumor growth and symptoms and tested whether our earlier finding that vertigo is associated with reduced QOL could be verified. RESULTS: The median follow-up time was 43 months (range, 9–115 months; SD, 21.48 months). Results are based on 703 clinical controls and 642 (SF-36) and 638 (GBI) questionnaires. Seven patients were lost to follow-up. Approximately 40% of patients were in need of treatment during follow-up. We found a statistically significant association between tinnitus and vertigo and tumor growth. Vertigo was found to significantly reduce QOL. There was a significant drop in the Social Function subscales of both SF-36 and GBI, possibly attributable to progressive hearing loss. Otherwise, there was no overall trend toward any change in QOL during the observation period. In addition, QOL seemed to be little affected by treatment. CONCLUSION: There was a small but statistically significant improvement in vestibular complaints and no change in the occurrence of tinnitus. Except for hearing loss caused by surgery, treatment did not affect symptoms or QOL significantly. Growth was associated with the occurrence of tinnitus and balance problems.

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Untreated Vestibular Schwannoma: Vertigo Is a Powerful Predictor Forhealth-Related Quality of Life

Neurosurgery ◽

10.1227/01.neu.0000219838.80931.6b ◽

2006 ◽

Vol 59 (1) ◽

pp. 67-76 ◽

Cited By ~ 91

Author(s):

Erling Myrseth ◽

Per Møller ◽

Tore Wentzel-Larsen ◽

Frederik Goplen ◽

Morten Lund-Johansen

Keyword(s):

Quality Of Life ◽

Hearing Loss ◽

Vestibular Schwannoma ◽

Short Form ◽

Unilateral Hearing Loss ◽

Case Report Form ◽

Short Form 36 ◽

Glasgow Benefit Inventory ◽

Sf 36

Abstract OBJECTIVE The aim of the present study was to characterise the relation between quality of life (QOL) and the four major complaints (hearing loss, tinnitus, vertigo and unsteadiness) caused by unilateral vestibular schwannoma (versus) in a cohort of well-characterised untreated patients. METHODS One hundred and ninety-nine consecutive patients (91 men, 108 women) with a mean age of 56.9 years were studied prospectively during the 4-year period 2001–2004. The average time span from symptom onset to the radiological diagnosis was 4.2 years. The patients were subject to a standardised examination including MRI, evaluation of hearing acuity, balance function by stabilometry, and a visual analogue scale (VAS) self-evaluation of tinnitus and vertigo. Furthermore, the patients responded to two questionnaires, Short-Form 36 (SF-36) and Glasgow Benefit Inventory (GBI)). A reference population was recruited from 80 adult persons who visited Haukeland University Hospital as non-patients or non-staff members. All data were recorded prospectively in a customised case report form. Statistical analysis was done with SPSS software. RESULTS The response rates of the Short-Form 36 and Glasgow Benefit Inventoryquestionnaires were 91.5 and 89.9%, respectively. According to the SF-36 questionnaire the patients scored significantly below that of expected norms with exception of physical function and mental health. Patients report negative benefit on the general and physical sections of the GBI questionnaire. Regression analysis showed that vertigo had a strong negative impact on QOL, whilst unilateral hearing loss and tinnitus had less impact on QOL. CONCLUSION Vertigo is the symptom causing the most pronounced negative effect on QOL in patients with versus The more frequent versus-symptoms unilateral hearing loss and tinnitus seem to be less important in the patients' perception of QOL evaluated by the questionnaires used in this study. If vertigo could be relieved by treatment, this symptom should be more in focus when discussing treatment options in small to medium sized versus

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Unilateral Profound Hearing Loss and the Effect on Quality of Life After Cerebellopontine Angle Surgery

Otolaryngology ◽

10.1016/j.otohns.2005.05.017 ◽

2005 ◽

Vol 133 (3) ◽

pp. 339-346 ◽

Cited By ~ 13

Author(s):

Kavitha Subramaniam ◽

Robert H. Eikelboom ◽

Katrise M. Eager ◽

Marcus D. Atlas

Keyword(s):

Quality Of Life ◽

Hearing Loss ◽

Sound Localization ◽

Cerebellopontine Angle ◽

Life Questionnaire ◽

Speech Discrimination ◽

Profound Hearing Loss ◽

Cross Sectional ◽

Glasgow Benefit Inventory

OBJECTIVE: To assess patients’ quality of life after cerebellopontine angle surgery, and in particular, quality of life related to unilateral profound hearing loss. STUDY DESIGN AND SETTING: Cross-sectional in a tertiary referral center. Quality of life of 51 postoperative patients was assessed by using the Glasgow Benefit Inventory (GBI). Thirty patients with unilateral profound hearing loss who had undergone the translabyrinthine approach completed a subsequent quality-of-life questionnaire on speech discrimination and sound localization. RESULTS: Ninety-four percent of respondents to the 2nd survey reported difficulties with speech discrimination, and 97%, with sound localization. The general health and overall GBI indices correlated significantly ( P >0.01) with a number of speech and localization difficulties. CONCLUSION: Unilateral profound hearing loss may be a significant factor in a change in quality of life after cerebellopontine angle surgery. SIGNIFICANCE: Rehabilitation devices that improve discrimination and localization, and hearing preservation surgery, if indicated, should be considered for these patients.

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Disease-Specific Quality of Life in Vestibular Schwannoma: A National Cross-sectional Study Comparing Microsurgery, Radiosurgery, and Observation

Otolaryngology ◽

10.1177/0194599820941012 ◽

2020 ◽

pp. 019459982094101

Author(s):

Cynthia M. Chweya ◽

Nicole M. Tombers ◽

Christine M. Lohse ◽

Michael J. Link ◽

Matthew L. Carlson

Keyword(s):

Quality Of Life ◽

Hearing Loss ◽

Vestibular Schwannoma ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

The Impact ◽

Facial Function ◽

Disease Specific

Objective To examine the impact of treatment on disease-specific health-related quality of life (HRQOL) among patients with sporadic vestibular schwannoma (VS). Study Design National cross-sectional study. Setting Tertiary referral center and the Acoustic Neuroma Association. Subjects and Methods Adult patients with VS who completed the Penn Acoustic Neuroma Quality of Life (PANQOL) survey. Patients were classified by treatment at the most recent survey as microsurgery, radiosurgery, observation, or recently diagnosed (RD). PANQOL scores were compared among VS treatment groups and with nontumor controls using analysis of covariance. Results A total of 1362 respondents with VS were analyzed. Total PANQOL scores differed significantly by treatment ( P = .024) with adjusted means of 60, 63, 65, and 62 for the microsurgery, radiosurgery, observation, and RD groups, respectively. Subdomain scores for facial function, balance, hearing loss, and pain differed significantly ( P < .05) by treatment. Comparisons that surpassed thresholds for clinical significance included microsurgery compared to radiosurgery and observation for facial function, microsurgery compared to observation and RD for hearing loss, and microsurgery compared to radiosurgery and observation for pain. Subdomain scores for anxiety, facial function, balance, hearing loss, energy, and pain and total PANQOL scores for nontumor controls were significantly higher (ie, more favorable) compared to the VS groups ( P < .05). General health scores did not differ significantly between the nontumor controls and the VS groups ( P = .19). Conclusion Differences in HRQOL among treatment modalities are small and variably exceed the minimal clinically important difference. The impact of a VS diagnosis on HRQOL supersedes that of the treatment type.

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