Hearing preservation in the resection of vestibular schwannomas: patterns of hearing preservation and patient-assessed hearing function

Clinical article

View More View Less
  • 1 Department of Neurological Surgery, George Washington University, Washington, DC;
  • 2 Stritch School of Medicine; and
  • 3 Departments of Neurological Surgery,
  • 4 Otolaryngology, Head and Neck Surgery, and
  • 5 Audiology, Loyola University Medical Center, Maywood, Illinois
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

No extant literature documents the analysis of patient perceptions of hearing as a corollary to objective audiometric measures in patients with vestibular schwannoma (VS), or acoustic neuroma. Therefore, using objective audiometric data and patient perceptions of hearing function as outlined on a questionnaire, the authors evaluated the hearing of patients who underwent VS resection.

Methods

This investigation involved a retrospective review of 176 patients who had undergone VS resections in which hearing preservation was a goal. Both pre- and postoperative audiometry, expressed as a speech discrimination score (SDS) and pure tone threshold average (PTA), were performed, and the results were analyzed. Intraoperative auditory brainstem responses were also recorded. Eighty-seven of the patients (49.4%) completed a postoperative questionnaire designed to assess hearing function in a variety of social and auditory situations. Multiple linear regression analyses were completed to compare available audiometric results with questionnaire responses for each patient.

Results

One hundred forty-two patients (80.7%) had PTA and SDS audiometric data pertaining to the surgically treated ear; 94 of these patients (66.2%) had measurable postoperative hearing, as defined by a PTA < 120 dB or SD > 0%. Eighty-seven patients (49.4%) completed the retrospective questionnaire, and 74 of them had complete audiometric data and thus were included in a comparative analysis. Questionnaire data showed major postoperative subjective hearing decrements, even among patients with the same pre- and postoperative objective audiometric hearing status. Moreover, the subscore reflecting hearing while exposed to background noise, or the “cocktail party effect,” characterized the most significant patient-perceived hearing deficit following VS resection.

Conclusions

The authors' analysis of a patient-perceived hearing questionnaire showed that hearing during exposure to background noise, or the cocktail party effect, represents a significant postoperative hearing deficit and that patient perception of this deficit has a strong relation with audiometric data. Furthermore, questionnaire responses revealed a significant disparity between subjective hearing function and standard audiometrics such that even with similar levels of audiometric data, subjective measures of hearing, especially the cocktail party effect, decreased postoperatively. The authors posit that the incorporation of patient-perceived hearing function evaluation along with standard audiometry is an illustrative means of identifying subjective hearing deficits after VS resection and may ultimately aid in specific and subsequent treatment for these patients.

Abbreviations used in this paper: AAO-HNS = American Academy of Otolaryngology–Head and Neck Surgery; PTA = pure tone threshold average; QOL = quality of life; SD = speech discrimination; SDS = SD score; VS = vestibular schwannoma.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Douglas E. Anderson, M.D., Department of Neurological Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois 60153. email: dander1@lumc.edu.

Please include this information when citing this paper: published online December 17, 2010; DOI: 10.3171/2010.11.JNS091752.

  • 1

    Anderson DE, , Leonetti J, , Wind JJ, , Cribari D, & Fahey K: Resection of large vestibular schwannomas: facial nerve preservation in the context of surgical approach and patient-assessed outcome. J Neurosurg 102:643649, 2005

    • Search Google Scholar
    • Export Citation
  • 2

    Arlinger S: Negative consequences of uncorrected hearing loss—a review. Int J Audiol 42:Suppl 2 2S172S20, 2003

  • 3

    Bento RF, , De Brito RV, , Sanchez TG, & Miniti A: The transmastoid retrolabyrinthine approach in vestibular schwannoma surgery. Otolaryngol Head Neck Surg 127:437441, 2002

    • Search Google Scholar
    • Export Citation
  • 4

    Betchen SA, , Walsh J, & Post KD: Long-term hearing preservation after surgery for vestibular schwannoma. J Neurosurg 102:69, 2005

  • 5

    Chee GH, , Nedzelski JM, & Rowed D: Acoustic neuroma surgery: the results of long-term hearing preservation. Otol Neurotol 24:672676, 2003

    • Search Google Scholar
    • Export Citation
  • 6

    Cox RM, & Alexander GC: The abbreviated profile of hearing aid benefit. Ear Hear 16:176186, 1995

  • 7

    Cox RM, & Rivera IM: Predictability and reliability of hearing aid benefit measured using the PHAB. J Am Acad Audiol 3:242254, 1992

  • 8

    Ebersold MJ, , Harner SG, , Beatty CW, , Harper CM Jr, & Quast LM: Current results of the retrosigmoid approach to acoustic neurinoma. J Neurosurg 76:901909, 1992

    • Search Google Scholar
    • Export Citation
  • 9

    Frerebeau P, , Benezech J, , Uziel A, , Coubes P, , Segnarbieux F, & Malonga M: Hearing preservation after acoustic neurinoma operation. Neurosurgery 21:197200, 1987

    • Search Google Scholar
    • Export Citation
  • 10

    Friedman RA, , Kesser B, , Brackmann DE, , Fisher LM, , Slattery WH, & Hitselberger WE: Long-term hearing preservation after middle fossa removal of vestibular schwannoma. Otolaryngol Head Neck Surg 129:660665, 2003

    • Search Google Scholar
    • Export Citation
  • 11

    Gjurić M, , Wigand ME, & Wolf SR: Enlarged middle fossa vestibular schwannoma surgery: experience with 735 cases. Otol Neurotol 22:223231, 2001

    • Search Google Scholar
    • Export Citation
  • 12

    Holsinger FC, , Coker NJ, & Jenkins HA: Hearing preservation in conservation surgery for vestibular schwannoma. Am J Otol 21:695700, 2000

    • Search Google Scholar
    • Export Citation
  • 13

    Inoue Y, , Ogawa K, & Kanzaki J: Quality of life of vestibular schwannoma patients after surgery. Acta Otolaryngol 121:5961, 2001

  • 14

    Irving RM, , Beynon GJ, , Viani L, , Hardy DG, , Baguley DM, & Moffat DA: The patient's perspective after vestibular schwannoma removal: quality of life and implications for management. Am J Otol 16:331337, 1995

    • Search Google Scholar
    • Export Citation
  • 15

    Kanzaki J, , Ogawa K, , Inoue Y, , Shiobara R, & Toya S: Quality of hearing preservation in acoustic neuroma surgery. Am J Otol 19:644648, 1998

    • Search Google Scholar
    • Export Citation
  • 16

    Kaylie DM, , Gilbert E, , Horgan MA, , Delashaw JB, & McMenomey SO: Acoustic neuroma surgery outcomes. Otol Neurotol 22:686689, 2001

  • 17

    Koerbel A, , Gharabaghi A, , Safavi-Abbasi S, , Tatagiba M, & Samii M: Evolution of vestibular schwannoma surgery: the long journey to current success. Neurosurg Focus 18:4 e10, 2005

    • Search Google Scholar
    • Export Citation
  • 18

    Levo H, , Blomstedt G, & Pyykkö I: Is hearing preservation useful in vestibular schwannoma surgery?. Ann Otol Rhinol Laryngol 111:392396, 2002

    • Search Google Scholar
    • Export Citation
  • 19

    Machinis TG, , Fountas KN, , Dimopoulos V, & Robinson JS: History of acoustic neurinoma surgery. Neurosurg Focus 18:4 e9, 2005

  • 20

    Magliulo G, , Zardo F, , Damico R, , Varacalli S, & Forino M: Acoustic neuroma: postoperative quality of life. J Otolaryngol 29:344347, 2000

  • 21

    Martin HC, , Sethi J, , Lang D, , Neil-Dwyer G, , Lutman ME, & Yardley L: Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life. J Neurosurg 94:211216, 2001

    • Search Google Scholar
    • Export Citation
  • 22

    Matthies C, & Samii M: Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery 40:110, 1997

  • 23

    Mirz F, , Pedersen CB, , Fiirgaard B, & Lundorf E: Incidence and growth pattern of vestibular schwannomas in a Danish county, 1977–98. Acta Otolaryngol Suppl 543:3033, 2000

    • Search Google Scholar
    • Export Citation
  • 24

    Moffat DA, , da Cruz MJ, , Baguley DM, , Beynon GJ, & Hardy DG: Hearing preservation in solitary vestibular schwannoma surgery using the retrosigmoid approach. Otolaryngol Head Neck Surg 121:781788, 1999

    • Search Google Scholar
    • Export Citation
  • 25

    Mohr G, , Sade B, , Dufour JJ, & Rappaport JM: Preservation of hearing in patients undergoing microsurgery for vestibular schwannoma: degree of meatal filling. J Neurosurg 102:15, 2005

    • Search Google Scholar
    • Export Citation
  • 26

    Nadol JB Jr, , Chiong CM, , Ojemann RG, , McKenna MJ, , Martuza RL, & Montgomery WW, : Preservation of hearing and facial nerve function in resection of acoustic neuroma. Laryngoscope 102:11531158, 1992

    • Search Google Scholar
    • Export Citation
  • 27

    Nikolopoulos TP, , Johnson I, & O'Donoghue GM: Quality of life after acoustic neuroma surgery. Laryngoscope 108:13821385, 1998

  • 28

    Norén G: Gamma knife radiosurgery of acoustic neurinomas. A historic perspective. Neurochirurgie 50:253256, 2004

  • 29

    Pellet W, & Roche PH: [Evolution of vestibular schwannoma surgery.]. Neurochirurgie 50:160194, 2004. Fr

  • 30

    Raffin MJ, , Nourie FJ, , Leonetti JP, , Anderson D, & Sinclair JS: Quantitative Methods in the Analysis of Pure-Tone Audiometry. (http://www.audiologyonline.com/articles/article_detail.asp?article_id=1206) [Accessed November 9, 2010]

    • Search Google Scholar
    • Export Citation
  • 31

    Raffin MJ, & Thornton AR: Confidence levels for differences between speech-discrimination scores. A research note. J Speech Hear Res 23:518, 1980

    • Search Google Scholar
    • Export Citation
  • 32

    Rappaport JM, , Nadol JB Jr, , McKenna MJ, , Ojemann RG, , Thornton AR, & Cortese RA: Standardized format for depicting hearing preservation results in the management of acoustic neuroma. Otolaryngol Head Neck Surg 121:176179, 1999

    • Search Google Scholar
    • Export Citation
  • 33

    Sanna M, , Khrais T, , Russo A, , Piccirillo E, & Augurio A: Hearing preservation surgery in vestibular schwannoma: the hidden truth. Ann Otol Rhinol Laryngol 113:156163, 2004

    • Search Google Scholar
    • Export Citation
  • 34

    Staecker H, , Nadol JB Jr, , Ojeman R, , Ronner S, & McKenna MJ: Hearing preservation in acoustic neuroma surgery: middle fossa versus retrosigmoid approach. Am J Otol 21:399404, 2000

    • Search Google Scholar
    • Export Citation
  • 35

    Tonn JC, , Schlake HP, , Goldbrunner R, , Milewski C, , Helms J, & Roosen K: Acoustic neuroma surgery as an interdisciplinary approach: a neurosurgical series of 508 patients. J Neurol Neurosurg Psychiatry 69:161166, 2000

    • Search Google Scholar
    • Export Citation
  • 36

    Wiegand DA, & Fickel V: Acoustic neuroma—the patient's perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients. Laryngoscope 99:179187, 1989

    • Search Google Scholar
    • Export Citation
  • 37

    Wiet RJ, , Mamikoglu B, , Odom L, & Hoistad DL: Long-term results of the first 500 cases of acoustic neuroma surgery. Otolaryngol Head Neck Surg 124:645651, 2001

    • Search Google Scholar
    • Export Citation
  • 38

    Yoshimoto Y: Systematic review of the natural history of vestibular schwannoma. J Neurosurg 103:5963, 2005

Metrics

All Time Past Year Past 30 Days
Abstract Views 437 115 7
Full Text Views 125 9 1
PDF Downloads 198 9 0
EPUB Downloads 0 0 0