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Hearing Preservation (hearing + preservation)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Nerve of Origin, Tumor Size, Hearing Preservation, and Facial Nerve Outcomes in 359 Vestibular Schwannoma Resections at a Tertiary Care Academic Center

THE LARYNGOSCOPE, Issue 12 2007
Abraham Jacob MD
Abstract Objective: To determine nerve of origin, tumor size, hearing preservation rates, and facial nerve outcomes in a retrospective cohort study of patients undergoing translabyrinthine (TL), middle cranial fossa (MCF), and retrosigmoid/suboccipital (SO) approaches to vestibular schwannomas (VS). Study Design: Retrospective. Methods: Chart review. Results: Patient charts from 231 TL, 70 MCF, 53 SO, and 5 combined TL/SO procedures for VS were evaluated in 356 patients. The inferior vestibular nerve (IVN) was the nerve of origin in 84 of 359 cases (23.3%), while the superior vestibular nerve (SVN) was the nerve of origin in 36 patients (10%). In 239 of 359 cases (66.6%), the nerve of origin was not identified. Forty patients undergoing hearing preservation surgery had hearing results and nerve of origin data available for review. Functional hearing (<50dB PTA and >50% speech discrimination) was preserved in 10 of 15 patients (75%) with SVN tumors, while only 7 of 25 patients (28%) with IVN tumors retained functional hearing. Facial nerve outcomes and nerve of origin were recorded simultaneously in 109 patients. Seventy-one of 74 patients (95%) patients with IVN tumors achieved a House-Brackmann (HB) grade I,III, while 35 of 35 patients (100%) with SVN tumors retained HB I,III facial function. Looking at tumor size versus hearing preservation, functional hearing was preserved in 22 of 49 patients (45%) with <1-cm tumors, and 4 of 20 patients (20%) with 1- to 1.5-cm tumors. For all cases with documented facial nerve function, HB I,III were achieved in 96% of SO, 94% of MCF, and 88% of TL procedures. Conclusions: Our retrospective data indicated that IVN tumors were twice as common as SVN tumors. The nerve of origin did not affect facial nerve outcomes but did impact hearing preservation rates. Patients with tumors <1 cm in size had the best chance for hearing preservation. Overall facial nerve preservation was excellent with >90% achieving HB 1 to 3 function at final follow-up. [source]

Modified Translabyrinthine Approach and Hearing Preservation

THE LARYNGOSCOPE, Issue 6 2004
Giuseppe Magliulo MD
Abstract Objectives/Hypothesis: In 1991, the translabyrinthine approach was modified by sealing the vestibule with bone wax, which allowed preservation of the hearing function in one patient. The present study aimed specifically at evaluating the effectiveness of the modified translabyrinthine approach in preserving hearing function in a group of patients with vestibular schwannoma that involved the internal auditory canal. Study Design: Prospective study. Methods: The series consisted of 12 patients with vestibular schwannoma (average age, 49.7 y). The schwannoma was smaller than 2 cm in all patients who had surgery. The patients accepted for the study were required to have preserved hearing function. Results: None of the patients has shown signs of persistence or tumoral relapse on postoperative magnetic resonance imaging. Immediately after surgery, the entire group had excellent facial functionality. Six patients had maintained their hearing function (four in Class 1 and two in Class 2 according to the Gardner-Robertson scale) at the last follow-up after surgery. A patient during follow-up noted fluctuating hearing contemporarily with a tinnitus in the ear that had maintained its hearing, which was attributable to an endolymphatic hydrops. Three of the six patients with preserved hearing complained of persistent tinnitus. None of the patients had any of the complications or consequences of cerebellopontine surgery. Conclusion: In our patients, Class 1 or 2 hearing was preserved in 50% of the patients, with no persistence or tumoral relapse. The follow-up has obviously been short, but the first results are encouraging and deserve to be studied further in a more comprehensive survey. [source]

Conservative versus primary surgical treatment of acoustic neuromas: a comparison of rates of facial nerve and hearing preservation

CLINICAL OTOLARYNGOLOGY, Issue 3 2008
T.P.C. Martin
Objectives:, To determine whether patients with small to medium sized acoustic neuromas managed conservatively suffer reduced rates of facial nerve and hearing preservation when compared with patients undergoing primary surgery. Design:, An intention-to-treat comparison between patients managed conservatively at first presentation and those managed with primary surgery. Setting:, Tertiary referral neurotological centre in Birmingham, UK. Participants:, Data were drawn from our database of 487 sporadic acoustic neuromas managed from 1997 to present day. Main outcome measures:, Facial nerve status (assessed using the House-Brackmann system) was collated for all conservatively managed patients (n = 167) and compared with that expected when calculated from primarily surgically managed tumours of equivalent size (n = 121). A chi-square test was employed to test the statistical significance of any difference. Hearing preservation (maintenance of AAO-HNS Class) in patients presenting with Class A or B hearing was compared between conservatively managed patients and those with primary surgical management. Results:, Observed facial nerve preservation in conservatively managed patients was significantly better (P < 0.001) than expected when calculated from rates of facial nerve preservation in surgically managed patients. Hearing preservation was also significantly more successful in conservatively managed patients (Pearson chi-square: P < 0.000). Conclusions:, An initial period of conservative management is a safe and reasonable management policy in all acoustic neuromas up to 2 cm in size at the cerebello-pontine angle. Given that there are no failsafe ways of deciding potential for growth in acoustic neuromas, initial conservative management of these tumours offers superior hearing and facial nerve preservation when compared with primary surgical treatment. [source]

Nerve of Origin, Tumor Size, Hearing Preservation, and Facial Nerve Outcomes in 359 Vestibular Schwannoma Resections at a Tertiary Care Academic Center

Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

CANCER, Issue 2 2009
Tumor control, hearing preservation
Abstract BACKGROUND: The radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2 (NF2) is controversial. The authors investigated the radiologically proven tumor control rate after gamma knife radiosurgery. The factors that affect tumor control and serviceable hearing preservation were analyzed. METHODS: Thirty-six lesions in 30 patients were included. The median lengths of the clinical and radiologic follow-ups were 48.5 months and 36.5 months, respectively. The median tumor volume was 3.2 cm3. The mean marginal dose was 12.1 grays (Gy) (range, 8,14 Gy) at an isodose line of 50%±0.6%. The Kaplan-Meier method and Cox proportional hazards model were used for the statistical analyses. RESULTS: The actuarial tumor control rate was 81%, 74%, and 66%, respectively, in the first, second, and fifth years. Five tumors required a salvage surgery because of tumor control failure. A low marginal dose and a young age at radiosurgery were associated with poor tumor control. Of the 16 tumors with which ipsilateral hearing was serviceable, the actuarial serviceable hearing preservation rates were 50%, 45%, and 33%, respectively, in the first, second, and fifth years. Better ipsilateral hearing (Gardner-Robertson grade 1, compared with grade 2) at the time of radiosurgery was associated with significantly greater serviceable hearing preservation. CONCLUSIONS: Gamma knife radiosurgery for vestibular schwannomas in NF2 patients provided 5-year tumor control in approximately two-thirds of patients and preserved serviceable hearing in approximately one-third. The rates of other cranial nerve deficits were low, and no secondary malignancy was observed. Radiosurgery should be included in treatment options for NF2 patients. Cancer 2009. © 2009 American Cancer Society. [source]

Electric acoustic stimulation of the auditory system: experience and results of ten patients using MED-EL's M and FlexEAS electrodes

CLINICAL OTOLARYNGOLOGY, Issue 3 2010
A. Lee
Clin. Otolaryngol. 2010, 35, 190,197 Objective:, To evaluate the hearing preservation rate and speech perception scores in patients with profound high frequency hearing loss and acoustically aidable low frequency hearing, managed with the MED-EL electric acoustic stimulation system referenced to the insertion depth of the electrode array. Study design:, Retrospective data analysis. Participants and setting:, Ten patients implanted at the Auditory Implant Centre, Guy's and St Thomas's Hospital, London, UK. Main outcome measures:, Pure tone audiometry, speech perception tests and electrode insertion depth angle. Results:, Postoperatively, functional hearing preservation allowing electric acoustic stimulation was achieved in eight patients and total preservation of residual hearing in five patients with follow-up periods of more than 12 months. Three of four (75%) patients with an insertion depth of >360° had a threshold shift of >25 dB, and all four patients had a threshold shift of >10 dB. All patients with total hearing preservation had the electrode inserted up to 360° at maximum. Overall, speech perception outcomes increased significantly and hearing impairment was significantly reduced after electric acoustic stimulation or electric stimulation alone as compared with the preoperative scores. Conclusion:, Electric acoustic stimulation provides significant benefit to individuals with profound high frequency hearing loss. Studies with larger number of patients are needed to establish the optimal electrode insertion angle as well as to further analyse the benefit of electric acoustic stimulation. [source]

Conservative versus primary surgical treatment of acoustic neuromas: a comparison of rates of facial nerve and hearing preservation

Tympanoplasty , reporting hearing results and ,hearing objective'

CLINICAL OTOLARYNGOLOGY, Issue 6 2004
P.J.D. Dawes
When reporting the results of tympanoplasty, the postoperative air,bone gap (ABG) presented in 10 dB bins, ABG closure and air conduction threshold gain are commonly reported indicators of tympanoplasty outcome. When tympanoplasty is performed, the reconstruction aims either to improve hearing threshold or to maintain satisfactory thresholds, that is, the surgical intention is either for ,hearing gain' or for ,hearing preservation'. This review of the early results of tympanoplasty examines whether classifying surgery as either for hearing gain or for hearing preservation influences the reported results. Closure of the ABG to within 20 dB was achieved in 72,94% of cases, the average postoperative ABG was between 13.1 and 17.1 dB with the postoperative air conduction threshold being between 27.4 and 33.5 dB. These figures were similar for both hearing preservation and hearing gain procedures. However air conduction threshold gain was significantly greater for the ,hearing gain' group (17 dB versus 0 dB) and was reduced to 8 dB by combining the two groups. Overall, indicating whether surgery attempted hearing preservation or hearing gain did not significantly alter the parameters used for reporting tympanoplasty outcome. [source]