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

Clinical article

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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.

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: thirumalapd@upmc.edu.

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.

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