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.

Criteria for hearing preservation in acoustic schwannoma surgery: The concept of useful hearing

1992 ◽  
Vol 106 (6) ◽  
pp. 500-503 ◽  
Author(s):  
A. E. Hinton ◽  
R. T. Ramsden ◽  
R. H. Lye ◽  
J. E. M. Dutton
Keyword(s):  
Pure Tone ◽  
Tumour Size ◽  
Hearing Preservation ◽  
Discrimination Score ◽  
Speech Discrimination ◽  
Average Difference ◽  
Pure Tone Audiogram ◽  
Speech Discrimination Score ◽  
Acoustic Schwannoma

AbstractIn the quest for hearing preservation in patients with acoustic schwannomas it is essential that surgeons do not lose sight of the concept of ‘useful’ hearing. There is an important difference between hearing preservation which pleases the surgeon and that which will be appreciated by the patient.Tumour size, pure tone audiogram average differences between ears and speech discrimination scores have been recorded in a series of 114 patients with unilateral acoustic schwannomas. Criteria for useful hearing are presented in terms of pure tone audiogram average difference and speech discrimination scores.There were 11 patients (10 per cent) with a speech discrimination score of 50 per cent or more, a pure tone audiogram average difference of 30 dB or better and a tumour size of no more than 2 cm. Only one patient (0.9 per cent) had a speech discrimination score of 50 per cent or more, a pure tone audiogram average difference of 20 dB or better and a tumour size of no more than 1 cm.It is concluded that hearing preservation techniques may be applicable to between 1 and 10 per cent of patients with unilateral acoustic schwannomas.

Intratympanic steroid injection as a salvage treatment for sudden sensorineural hearing loss

2014 ◽  
Vol 128 (12) ◽  
pp. 1044-1049 ◽  
Author(s):  
S Belhassen ◽  
I Saliba
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Pure Tone ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Discrimination Score ◽  
Speech Discrimination ◽  
Low Frequencies ◽  
Pure Tone Average ◽  
Speech Discrimination Score

AbstractObjective:To determine the efficacy of intratympanic methylprednisolone injections for treating sudden sensorineural hearing loss.Method:A retrospective chart review was performed to identify patients suffering from sudden sensorineural hearing loss with no recovery after oral steroids. Patients were given up to three intratympanic methylprednisolone injections at one-week intervals. They were classified according to their functional hearing class, remission was monitored and potential factors affecting prognosis were analysed.Results:Intratympanic injections provide effective salvage therapy for sudden sensorineural hearing loss (p = 0.039). Changes in pure tone average and speech discrimination score were analysed following intratympanic methylprednisolone injections. The pure tone average reached a plateau after the second injection; however, the speech discrimination score improved until after the third injection. Hearing improvement after intratympanic injections mainly occurred at low frequencies. The interval between symptoms appearing and intratympanic injections starting was not significantly associated with remission (p = 0.680).Conclusion:A delay between symptom onset and the first intratympanic methylprednisolone injection does not seem to affect prognosis.

scholarly journals Words in noise audiometry in adult subjects with normal hearing

2020 ◽  
Vol 50 (1) ◽  
pp. 9
Author(s):  
Widayat Alviandi ◽  
Jenny Bashiruddin ◽  
Brastho Bramantyo ◽  
Farisa Rizky
Keyword(s):  
Speech Recognition ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Normal Hearing ◽  
Recognition Threshold ◽  
Speech Audiometry ◽  
Discrimination Score ◽  
Speech Discrimination ◽  
Speech Discrimination Score ◽  
Noise Test

Background: Patients with hearing disturbance will generally undergo pure tone audiometry andspeech audiometry in a quiet room, but those examinations cannot evaluate the ability to understand speech in daily environment with a noisy background. Words in noise test will provide valuable informationregarding patient’s hearing problem in noise. Purpose: To evaluate the hearing threshold using wordsin noise test in adults with normal hearing. Method: This cross-sectional study was conducted in CiptoMangunkusumo Hospital from January to April 2017. All subjects who fulfilled the inclusion and exclusioncriteria underwent pure tone audiometry, speech audiometry, and words in noise test. Results: A total of71 individuals with normal hearing were recruited for this study. Words in noise test showed the medianvalue of 67 dB and 100 dB for Speech Recognition Threshold (SRT) 50% and Speech DiscriminationScore (SDS) 100%, respectively. The SRT 50% and SDS 100% were significantly higher in the age group40–60 years compared to the age group 18–39 years. There was also a statistically significant differencebetween males and females at SRT 50% assessed by words in noise audiometry. Conclusion: Wordsin noise test showed a statistically significant difference in SRT 50% and SDS 100% between two agegroups, but no difference was found between genders. The result of this study can be used as a referencefor SRT and SDS values of speech audiometry test in noise.Keywords: words in noise, speech audiometry, speech recognition threshold, speech discrimination score ABSTRAKLatar belakang: Pasien dengan gangguan pendengaran umumnya menjalani pemeriksaanaudiometri nada murni dan audiometri tutur di ruangan yang sunyi, tetapi pemeriksaan ini tidakdapat menggambarkan kemampuan pemahaman wicara di lingkungan sehari-hari yang ramai. Testutur dalam bising dapat mengevaluasi masalah pendengaran pasien dalam keadaan bising. Tujuan:Untuk mengevaluasi ambang pendengaran menggunakan tes tutur dalam bising pada orang dewasadengan pendengaran normal. Metode: Penelitian potong lintang ini dilakukan di Rumah Sakit CiptoMangunkusumo dari Januari hingga April 2017. Semua subjek yang memenuhi kriteria inklusi daneksklusi menjalani pemeriksaan audiometri nada murni, audiometri tutur, dan tes tutur dalam bising.Hasil: Sebanyak 71 orang dengan pendengaran normal diikutsertakan dalam penelitian ini. Tes tuturdalam bising menunjukkan nilai median masing-masing 67 dB dan 100 dB pada Speech RecognitionThreshold (SRT) 50% dan Speech Discrimination Score (SDS) 100%. SRT 50% dan SDS 100% secarasignifikan lebih tinggi pada kelompok usia 40–60 tahun dibandingkan dengan kelompok usia 18–39 tahun. Hasil pemeriksaan tes tutur dalam bising menunjukkan perbedaan yang signifikan antara laki-laki dan wanita pada nilai SRT 50%. Kesimpulan: Tes tutur dalam bising menunjukkan perbedaan yang bermakna secara statistik pada SRT 50% dan SDS 100% antara dua kelompok umur, tetapi tidak ada perbedaan signifikan diantara jenis kelamin. Hasil penelitian ini dapat digunakan sebagai acuan untuk nilai SRT dan SDS pada pemeriksaan audiometri tutur dalam bising.

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.

Hearing preservation surgery in vestibular schwannoma

2006 ◽  
Vol 120 (5) ◽  
pp. 366-370 ◽  
Author(s):  
Tarek Khrais ◽  
Mario Sanna
Keyword(s):  
Vestibular Schwannoma ◽  
Tumour Size ◽  
Hearing Preservation ◽  
Neck Surgery ◽  
Hearing Level ◽  
Review Of Literature ◽  
Tertiary Referral Centre ◽  
Class A ◽  
Strong Inverse Relationship ◽  
Hearing Preservation Surgery

Objectives: To study the effect of pre-operative hearing level and tumour size on the hearing outcome of hearing preservation surgery for vestibular schwannoma.Study design and setting: A review of literature conducted at Gruppo Otologico, a tertiary referral centre for neurotology and skull base surgery.Results: A total of 1993 patients in 16 publications addressing the topic of hearing preservation surgery in vestibular schwannoma were analysed. The American Academy of Otolaryngology–Head and Neck Surgery hearing classification system was the classification upon which we based our analysis.Conclusion: Defining hearing preservation as class-A hearing, there was a strong inverse relationship between pre-operative hearing and post-operative hearing levels and between tumour size and post-operative hearing levels.

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.

Stability of Hearing over an Eight-Year Period following Wire-Vein Stapedectomy for Otosclerosis

1973 ◽  
Vol 82 (1) ◽  
pp. 13-16 ◽  
Author(s):  
Francis A. Sooy ◽  
Elmer Owens ◽  
Elizabeth S. Neufeld
Keyword(s):  
Postoperative Complications ◽  
Pure Tone ◽  
Test Results ◽  
Discrimination Score ◽  
Speech Discrimination ◽  
Speech Discrimination Score ◽  
Speech Reception ◽  
Percentage Points ◽  
Hearing Test ◽  
The Stability

This study was undertaken to determine the stability of hearing in patients over an eight-year period following a wire-vein graft stapedectomy procedure for otosclerosis. The method was to compare the four-month and eight-year postoperative hearing test results for a population of 76 patients who had undergone this procedure. No significant decrements in pure-tone thresholds were shown over the eight years for the speech frequencies (500, 1000, 2000 Hz). Decrements of approximately 0.5 dB and 1 dB per year over the eight-year period occurred for 4000 and 8000 Hz, respectively. These decrements did not seem to be associated with aging. A slight decrement of 2.8 percentage points in mean speech discrimination score was shown over the eight-year period, while no change occurred in mean speech reception threshold. There were no serious postoperative complications for this group of patients. These results indicated good stability of hearing over the eight years.

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.

Middle Fossa Approach for Resection of Vestibular Schwannomas: A Decade of Experience

2018 ◽  
Vol 16 (2) ◽  
pp. 147-158 ◽  
Author(s):  
Jennifer A Kosty ◽  
Shawn M Stevens ◽  
Yair M Gozal ◽  
Vincent A DiNapoli ◽  
Smruti K Patel ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Tumor Size ◽  
Pure Tone ◽  
Vestibular Schwannomas ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Pure Tone Average ◽  
Class A ◽  
The Mean

AbstractBACKGROUNDThe middle cranial fossa (MCF) approach is a challenging surgical technique for the resection of small and intermediate sized, primarily intracanalicular, vestibular schwannomas (VS), with the goal of hearing preservation (HP).OBJECTIVETo describe a decade-long, single institutional experience with the MCF approach for resection of VS.METHODSThis is a retrospective cohort study of 63 patients who underwent the MCF approach for resection of VS from 2006 to 2016. Audiometric data included pure-tone average (PTA), low-tone pure-tone average (LtPTA), word recognition score, and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification at presentation and follow-up. Patients with postoperative serviceable (AAO-HNS class A-B) and/or useful (AAO-HNS class A-C) hearing were compared to those without HP. Facial nerve function was assessed using the House–Brackmann scale.RESULTSThe mean age and duration of follow-up were 50 ± 13 yr and 21 ± 21 mo, respectively. The mean tumor size was 10 ± 4 mm. The serviceable and usable HP rates were 54% and 50%, respectively. Some residual hearing was preserved in 71% of patients. Large tumor size (P = .05), volume (P = .03), and extrameatal tumor extension (P = .03) were associated with poor audiometric outcomes. The presence of a fundal fluid cap (P = .01) was a favorable finding. At definitive testing, LtPTA was significantly better preserved than traditional PTA (P = .01). Facial nerve outcomes, tumor control rates, and durability of audiometric outcomes were excellent. 47% of patients pursued aural rehabilitation.CONCLUSIONIn our series, the MCF approach for VS provided excellent rates of tumor and facial nerve function, with durable serviceable HP.

scholarly journals The effects of N95 mask and face shield on speech perception among healthcare workers in the coronavirus disease 2019 pandemic scenario

2020 ◽  
Vol 134 (10) ◽  
pp. 895-898
Author(s):  
S V Bandaru ◽  
A M Augustine ◽  
A Lepcha ◽  
S Sebastian ◽  
M Gowri ◽  
...  
Keyword(s):  
Speech Perception ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Pure Tone Audiometry ◽  
Normal Hearing ◽  
Protective Equipment ◽  
Discrimination Score ◽  
Speech Discrimination ◽  
Speech Discrimination Score ◽  
Speech Reception

AbstractObjectiveThe current circumstances of the coronavirus disease 2019 pandemic necessitate the use of personal protective equipment in hospitals. N95 masks and face shields are being used as personal protective equipment to protect from aerosol-related spread of infection. Personal protective equipment, however, hampers communication. This study aimed to assess the effect of using an N95 mask and face shield on speech perception among healthcare workers with normal hearing.MethodsTwenty healthcare workers were recruited for the study. Pure tone audiometry was conducted to ensure normal hearing. Speech reception threshold and speech discrimination score were obtained, first without using personal protective equipment and then repeated with the audiologist wearing an N95 mask and face shield.ResultsA statistically significant increase in speech reception threshold (mean of 12.4 dB) and decrease in speech discrimination score (mean of 7 per cent) was found while using the personal protective equipment.ConclusionUse of personal protective equipment significantly impairs speech perception. Alternate communication strategies should be developed for effective communication.

Sign in / Sign up

Export Citation Format

Share Document