Incidence of high-frequency hearing loss after microvascular decompression for hemifacial spasm

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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).


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.


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.


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.

Abbreviations used in this paper:BAEP = brainstem auditory evoked potential; HFHL = high-frequency hearing loss; HFS = hemifacial spasm; IPL = interpeak latency; MVD = microvascular decompression; SPL = sound pressure level; w = Wave.

Article Information

Address correspondence to: Parthasarathy D. Thirumala, M.D., Center for Clinical Neurophysiology, Department of Neurological Surgery, UPMC Presbyterian, Suite B-400, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213. email:

Please include this information when citing this paper: published online February 8, 2013; DOI: 10.3171/2013.1.JNS121153.

© AANS, except where prohibited by US copyright law.



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    Mean pure tone threshold of patients before and after MVD for HFS in the ipsilateral (IPSI) and contralateral (CONTRA) ear. With increasing tone frequencies, an increasing proportion of patients exhibited hearing loss during postoperative audiometry. The mean postoperative changes in pure tone audiometry were greater in the ipsilateral ear than in the contralateral ear.



Chan ESuneson AUlfendahl M: Acoustic trauma causes reversible stiffness changes in auditory sensory cells. Neuroscience 83:9619681998


Clark WWBohne BA: Effects of noise on hearing. JAMA 281:165816591999


Committee on Hearing and Equilibrium: Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). Otolaryngol Head Neck Surg 113:1791801995


da Cruz MJFagan PAtlas MMcNeill C: Drill-induced hearing loss in the nonoperated ear. Otolaryngol Head Neck Surg 117:5555581997


Doménech JCarulla MTraserra J: Sensorineural high-frequency hearing loss after drill-generated acoustic trauma in tympanoplasty. Arch Otorhinolaryngol 246:2802821989


Farzanegan GGhasemi MPanahi FRaza MAlghasi M: Does drill-induced noise have an impact on sensorineural hearing during craniotomy procedure?. Br J Neurosurg 24:40452010


Guillaume DJKnight KMarquez CKraemer DFBardo DMNeuwelt EA: Cerebrospinal fluid shunting and hearing loss in patients treated for medulloblastoma. Clinical article. J Neurosurg Pediatr 9:4214272012


Hamernik RPPatterson JHTurrentine GAAhroon WA: The quantitative relation between sensory cell loss and hearing thresholds. Hear Res 38:1992111989


Hatayama TMøller AR: Correlation between latency and amplitude of peak V in the brainstem auditory evoked potentials: intraoperative recordings in microvascular decompression operations. Acta Neurochir (Wien) 140:6816871998


Hegewald MHeitman RWiederhold MLCooper JCGates GA: High-frequency electrostimulation hearing after mastoidectomy. Otolaryngol Head Neck Surg 100:49561989


Heinrich URFeltens R: Mechanisms underlying noise-induced hearing loss. Drug Discov Today Dis Mech 3:1311352006


Hilmi OJMckee RHAbel EWSpielmann PMHussain SS: Do high-speed drills generate high-frequency noise in mastoid surgery?. Otol Neurotol 33:252011


Jiang DBibas ASantuli CDonnelly NJeronimidis GO'Connor AF: Equivalent noise level generated by drilling onto the ossicular chain as measured by laser Doppler vibrometry: a temporal bone study. Laryngoscope 117:104010452007


Jo KWKim JWKong DSHong SHPark K: The patterns and risk factors of hearing loss following microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 153:102310302011


Karatas EMiman MCOzturan OErdem TKalcioglu MT: Contralateral normal ear after mastoid surgery: evaluation by otoacoustic emissions (mastoid drilling and hearing loss). ORL J Otorhinolaryngol Relat Spec 69:18242007


Kurian RKrupp NLSaunders JC: Tip link loss and recovery on chick short hair cells following intense exposure to sound. Hear Res 181:40502003


Le Prell CGYamashita DMinami SBYamasoba TMiller JM: Mechanisms of noise-induced hearing loss indicate multiple methods of prevention. Hear Res 226:22432007


Lee SHSong DGKim SLee JHKang DG: Results of auditory brainstem response monitoring of microvascular decompression: a prospective study of 22 patients with hemifacial spasm. Laryngoscope 119:188718922009


Marneffe VPolo GFischer CSindou M: [Microsurgical vascular decompression for hemifacial spasm. Follow-up over one year, clinical results and prognostic factors. Study of a series of 100 cases.]. Neurochirurgie 49:5275352003. (Fr)


Mehrparvar AHMirmohammadi SJGhoreyshi AMollasadeghi ALoukzadeh Z: High-frequency audiometry: a means for early diagnosis of noise-induced hearing loss. Noise Health 13:4024062011


Migirov LWolf M: Influence of drilling on the distortion product otoacoustic emissions in the non-operated ear. ORL J Otorhinolaryngol Relat Spec 71:1531562009


Oliveira DCLima MA: Low and high frequency tonal threshold audiometry: comparing hearing thresholds between smokers and non-smokers. Braz J Otorhinolaryngol 75:7387442009


Park KHong SHHong SDCho YSChung WHRyu NG: Patterns of hearing loss after microvascular decompression for hemifacial spasm. J Neurol Neurosurg Psychiatry 80:116511672009


Park PToung JSSmythe PTelian SALa Marca F: Unilateral sensorineural hearing loss after spine surgery: case report and review of the literature. Surg Neurol 66:4154192006


Pau HWJust TBornitz MLasurashvilli NZahnert T: Noise exposure of the inner ear during drilling a cochleostomy for cochlear implantation. Laryngoscope 117:5355402007


Polo GFischer CSindou MPMarneffe V: Brainstem auditory evoked potential monitoring during microvascular decompression for hemifacial spasm: intraoperative brainstem auditory evoked potential changes and warning values to prevent hearing loss—prospective study in a consecutive series of 84 patients. Neurosurgery 54:971062004


Schneider MEBelyantseva IAAzevedo RBKachar B: Rapid renewal of auditory hair bundles. Nature 418:8378382002


Shargorodsky JCurhan SGCurhan GCEavey R: Change in prevalence of hearing loss in US adolescents. JAMA 304:7727782010


Sindou MFJFobé JLCiriano DFischer C: Hearing prognosis and intraoperative guidance of brainstem auditory evoked potential in microvascular decompression. Laryngoscope 102:6786821992


Sindou MP: Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring. Acta Neurochir (Wien) 147:101910262005


Somma GPietroiusti AMagrini ACoppeta LAncona CGardi S: Extended high-frequency audiometry and noise induced hearing loss in cement workers. Am J Ind Med 51:4524622008


Thirumala PDKassasm ABHabeych MWichman KChang YFGardner P: Somatosensory evoked potential monitoring during endoscopic endonasal approach to skull base surgery: analysis of observed changes. Neurosurgery 69:ons64ons762011


Yin XStrömberg AKDuan M: Evaluation of the noise generated by otological electrical drills and suction during cadaver surgery. Acta Otolaryngol 131:113211352011


Zhao YYamoah ENGillespie PG: Regeneration of broken tip links and restoration of mechanical transduction in hair cells. Proc Natl Acad Sci U S A 93:15469154741996


Zou JBretlau PPyykkö IStarck JToppila E: Sensorineural hearing loss after vibration: an animal model for evaluating prevention and treatment of inner ear hearing loss. Acta Otolaryngol 121:1431482001




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