scholarly journals Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

2015 ◽  
Vol 123 (4) ◽  
pp. 1059-1064 ◽  
Author(s):  
Parthasarathy Thirumala ◽  
Andrew M. Frederickson ◽  
Jeffrey Balzer ◽  
Donald Crammond ◽  
Miguel E. Habeych ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
High Frequency ◽  
Auditory Evoked Potentials ◽  
Pure Tone Audiometry ◽  
Brainstem Auditory Evoked Potentials ◽  
Vestibulocochlear Nerve ◽  
High Frequency Hearing Loss ◽  
Technical Modifications

OBJECT Microvascular decompression is a safe and effective procedure to treat hemifacial spasm, but the operation poses some risk to the patient’s hearing. While severe sensorineural hearing loss across all frequencies occurs at a low rate in experienced hands, a recent study suggests that as many as one-half of patients who undergo this procedure may experience ipsilateral high-frequency hearing loss (HFHL), and as many as one-quarter may experience contralateral HFHL. While it has been suggested that drill-related noise may account for this finding, this study was designed to examine the effect of a number of techniques designed to protect the vestibulocochlear nerve from operative manipulation on the incidence of HFHL. METHODS Pure-tone audiometry was performed both preoperatively and postoperatively on 67 patients who underwent microvascular decompression for hemifacial spasm during the study period. A change of greater than 10 dB at either 4 kHz or 8 kHz was considered to be HFHL. Additionally, the authors analyzed intraoperative brainstem auditory evoked potentials from this patient cohort. RESULTS The incidence of ipsilateral HFHL in this cohort was 7.4%, while the incidence of contralateral HFHL was 4.5%. One patient (1.5%; also included in the HFHL group) experienced an ipsilateral nonserviceable hearing loss. CONCLUSIONS The reduced incidence of HFHL in this study suggests that technical modifications including performing the procedure without the use of fixed retraction may greatly reduce, but not eliminate, the occurrence of HFHL following microvascular decompression for hemifacial spasm.

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.

scholarly journals The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia

2015 ◽  
Vol 123 (6) ◽  
pp. 1500-1506 ◽  
Author(s):  
Parthasarathy Thirumala ◽  
Kristin Meigh ◽  
Navya Dasyam ◽  
Preethi Shankar ◽  
Kanika R. K. Sarma ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
High Frequency ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Contralateral Side ◽  
Glossopharyngeal Neuralgia ◽  
Ipsilateral Side ◽  
High Frequency Hearing Loss

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 trigeminal neuralgia (TGN), glossopharyngeal neuralgia (GPN), or geniculate neuralgia (GN). METHODS The authors analyzed preoperative and postoperative audiogram data and brainstem auditory evoked potentials (BAEPs) from 93 patients with TGN, 6 patients with GPN, and 8 patients with GN who underwent MVD. Differences in pure tone audiometry > 10 dB at frequencies of 0.25, 0.5, 1, 2, 4, and 8 kHz were calculated preoperatively and postoperatively for both the ipsilateral and the contralateral sides. Intraoperative monitoring records were analyzed and compared with the incidence of HFHL, which was defined as a change in pure tone audiometry > 10 dB at frequencies of 4 and 8 kHz. RESULTS The incidence of HFHL was 30.84% on the side ipsilateral to the surgery and 20.56% on the contralateral side. Of the 47 patients with HFHL, 20 had conductive hearing loss, and 2 experienced nonserviceable hearing loss after the surgery. The incidences of HFHL on the ipsilateral side at 4 and 8 kHz were 17.76% and 25.23%, respectively, and 8.41% and 15.89%, respectively, on the contralateral side. As the audiometric frequency increased, the number of patients with hearing loss increased. No significant postoperative difference was found between patients with and without HFHL in intraoperative BAEP waveforms. Sex, age, and affected side were not associated with an increase in the incidence of hearing loss. CONCLUSIONS High-frequency hearing loss occurred after MVD for TGN, GPN, or GN, and the greatest incidence occurred on the ipsilateral side. This hearing loss may be a result of drill-induced noise and/or transient loss of cerebrospinal fluid during the course of the procedure. Changes in intraoperative BAEP waveforms were not useful in predicting HFHL after MVD. Repeated postoperative audiological examinations may be useful in assessing the prognosis of HFHL.

scholarly journals Microvascular decompression for typical trigeminal neuralgia: Personal experience with intraoperative neuromonitoring with level-specific-CE-Chirp® brainstem auditory evoked potentials in preventing possible hearing loss

2020 ◽  
Vol 11 ◽  
pp. 388
Author(s):  
Luciano Mastronardi ◽  
Franco Caputi ◽  
Guglielmo Cacciotti ◽  
Carlo Giacobbo Scavo ◽  
Raffaelino Roperto ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Trigeminal Neuralgia ◽  
Evoked Potentials ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Auditory Evoked Potentials ◽  
Intraoperative Neuromonitoring ◽  
Brainstem Auditory Evoked Potentials ◽  
Group A ◽  
Group B

Background: Permanent hearing loss after posterior fossa microvascular decompression (MVD) for typical trigeminal neuralgia (TTN) is one of the possible complications of this procedure. Intraoperative brainstem auditory evoked potentials (BAEPs) are used for monitoring the function of cochlear nerve during cerebellopontine angle (CPA) microsurgery. Level-specific (LS)-CE-Chirp® BAEPs are the most recent evolution of classical click BAEP, performed both in clinical studies and during intraoperative neuromonitoring (IONM) of acoustic pathways during several neurosurgical procedures. Methods: Since February 2016, we routinely use LS-CE-Chirp® BAEPs for monitoring the function of cochlear nerve during CPA surgery, including MVD for trigeminal neuralgia. From September 2011 to December 2018, 71 MVDs for TTN were performed in our department, 47 without IONM of acoustic pathways (Group A), and, from February 2016, 24 with LS-CE-Chirp BAEP (Group B). Results: Two patients of Group A developed a permanent ipsilateral anacusia after MVD. In Group B, we did not observe any permanent acoustic deficit after surgery. In one case of Group B, during arachnoid dissection, intraoperative LS-CE-Chirp BAEP showed a temporary lag of V wave, resolved in 5 min after application of intracisternal diluted papaverine (0.3% solution without excipients). Conclusion: MVD is widely considered a definitive surgical procedure in the management of TTN. Even though posterior fossa MVD is a safe procedure, serious complications might occur. In particular, the use of IONM of acoustic pathways during MVD for TTN might contribute to prevention of postoperative hearing loss.

scholarly journals The Relevance of the High Frequency Audiometry in Tinnitus Patients with Normal Hearing in Conventional Pure-Tone Audiometry

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Veronika Vielsmeier ◽  
Astrid Lehner ◽  
Jürgen Strutz ◽  
Thomas Steffens ◽  
Peter M. Kreuzer ◽  
...  
Keyword(s):  
Hearing Loss ◽  
High Frequency ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Normal Hearing ◽  
High Frequency Hearing Loss ◽  
Additional Information ◽  
Tinnitus Severity ◽  
Hearing Thresholds ◽  
High Frequency Audiometry

Objective. The majority of tinnitus patients suffer from hearing loss. But a subgroup of tinnitus patients show normal hearing thresholds in the conventional pure-tone audiometry (125 Hz–8 kHz). Here we explored whether the results of the high frequency audiometry (>8 kHz) provide relevant additional information in tinnitus patients with normal conventional audiometry by comparing those with normal and pathological high frequency audiometry with respect to their demographic and clinical characteristics.Subjects and Methods. From the database of the Tinnitus Clinic at Regensburg we identified 75 patients with normal hearing thresholds in the conventional pure-tone audiometry. We contrasted these patients with normal and pathological high-frequency audiogram and compared them with respect to gender, age, tinnitus severity, pitch, laterality and duration, comorbid symptoms and triggers for tinnitus onset.Results. Patients with pathological high frequency audiometry were significantly older and had higher scores on the tinnitus questionnaires in comparison to patients with normal high frequency audiometry. Furthermore, there was an association of high frequency audiometry with the laterality of tinnitus.Conclusion. In tinnitus patients with normal pure-tone audiometry the high frequency audiometry provides useful additional information. The association between tinnitus laterality and asymmetry of the high frequency audiometry suggests a potential causal role for the high frequency hearing loss in tinnitus etiopathogenesis.

Real-time intraoperative monitoring of brainstem auditory evoked potentials during microvascular decompression for hemifacial spasm

2016 ◽  
Vol 125 (5) ◽  
pp. 1061-1067 ◽  
Author(s):  
Byung-Euk Joo ◽  
Sang-Ku Park ◽  
Kyung-Rae Cho ◽  
Doo-Sik Kong ◽  
Dae-Won Seo ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Hearing Impairment ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Intraoperative Monitoring ◽  
Auditory Evoked Potentials ◽  
Brainstem Auditory Evoked Potentials ◽  
Stimulation Rate ◽  
Preliminary Study ◽  
Warning Criteria

OBJECTIVE The aim of this study was to define a new protocol for intraoperative monitoring (IOM) of brainstem auditory evoked potentials (BAEPs) during microvascular decompression (MVD) surgery to treat hemifacial spasm (HFS) and to evaluate the usefulness of this new protocol to prevent hearing impairment. METHODS To define the optimal stimulation rate, estimate the number of trials to be averaged, and identify useful warning criteria in IOM of BAEPs, the authors performed a preliminary study of 13 patients with HFS in 2010. They increased the stimulation rate from 10.1 Hz/sec to 100.1 Hz/sec by 10-Hz increments, and they elevated the average time from 100 times to 1000 times by 100-unit increments at a fixed stimulus rate of 43.9 Hz. After defining the optimal stimulation rate and the number of trials that needed to be averaged for IOM of BAEPs, they also identified the useful warning criteria for this protocol for MVD surgery. From January to December 2013, 254 patients with HFS underwent MVD surgery following the new IOM of BAEPs protocol. Pure-tone audiometry and speech discrimination scoring were performed before surgery and 1 week after surgery. To evaluate the usefulness of the new protocol, the authors compared the incidence of postoperative hearing impairment with the results from the group that underwent MVD surgery prior to the new protocol. RESULTS Through a preliminary study, the authors confirmed that it was possible to obtain a reliable wave when using a stimulation rate of 43.9 Hz/sec and averaging 400 trials. Only a Wave V amplitude loss > 50% was useful as a warning criterion when using the new protocol. A reliable BAEP could be obtained in approximately 9.1 seconds. When the new protocol was used, 2 patients (0.8%) showed no recovery of Wave V amplitude loss > 50%, and only 1 of those 2 patients (0.39%) ultimately had postoperative hearing impairment. When compared with the outcomes in the pre-protocol group, hearing impairment incidence decreased significantly among patients who underwent surgery with the new protocol (0.39% vs 4.02%, p = 0.002). There were no significant differences between the 2 surgery groups regarding other complications, including facial palsy, sixth cranial nerve palsy, and vocal cord palsy. CONCLUSIONS There was a significant decrease in postoperative hearing impairment after MVD for HFS when the new protocol for IOM of BAEPs was used. Real-time IOM of BAEPs, which can obtain a reliable BAEP in less than 10 seconds, is a successful new procedure for preventing hearing impairment during MVD surgery for HFS.

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