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Hosoya M, Kurihara S, Koyama H, Komune N. Recent advances in Otology: Current landscape and future direction. Auris Nasus Larynx 2024; 51:605-616. [PMID: 38552424 DOI: 10.1016/j.anl.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/24/2023] [Accepted: 02/21/2024] [Indexed: 05/12/2024]
Abstract
Hearing is an essential sensation, and its deterioration leads to a significant decrease in the quality of life. Thus, great efforts have been made by otologists to preserve and recover hearing. Our knowledge regarding the field of otology has progressed with advances in technology, and otologists have sought to develop novel approaches in the field of otologic surgery to achieve higher hearing recovery or preservation rates. This requires knowledge regarding the anatomy of the temporal bone and the physiology of hearing. Basic research in the field of otology has progressed with advances in molecular biology and genetics. This review summarizes the current views and recent advances in the field of otology and otologic surgery, especially from the viewpoint of young Japanese clinician-scientists, and presents the perspectives and future directions for several topics in the field of otology. This review will aid next-generation researchers in understanding the recent advances and future challenges in the field of otology.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi Minato-ku, Tokyo, 105-8471, Japan
| | - Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8654, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1Maidashi Higashi-ku, Fukuoka 812-8582, Japan
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Kosaraju N, Moore LS, Mulders JY, Blevins NH. Sporadic vestibular schwannoma in a pediatric population: a case series. Childs Nerv Syst 2024; 40:635-645. [PMID: 37889276 DOI: 10.1007/s00381-023-06184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To describe the characteristics, management, and outcomes of pediatric patients with sporadic vestibular schwannoma (sVS). METHODS This was a case series at a tertiary care center. Patients were identified through a research repository and chart review. Interventions were microsurgery, stereotactic radiosurgery (SRS), and observation. Outcome measures were tumor control, facial nerve function, and hearing. RESULTS Eight patients over 2006-2022 fulfilled inclusion criteria (unilateral VS without genetic or clinical evidence of neurofibromatosis type 2 (NF2); age ≤ 21) with a mean age of 17 years (14-20). Average greatest tumor length in the internal auditory canal was 9.7 mm (4.0-16.1). Average greatest tumor dimension (4/8 tumors) in the cerebellopontine angle was 19.1 mm (11.3-26.8). Primary treatment was microsurgery in five (62.5%) patients, observation in two (25%), and SRS in one (12.5%). Four (80%) surgical patients had gross total resections, and one (20%) had regrowth post-near total resection and underwent SRS. One observed patient and the primary SRS patient have remained radiographically stable for 3.5 and 7 years, respectively. The other observed patient required surgery for tumor growth after 12 months of observation. Two surgical patients had poor facial nerve outcomes. All post-procedural patients developed anacusis. Mean follow-up was 3 years (0.5-7). CONCLUSIONS We describe one of the largest reported cohorts of pediatric sVS in the USA. Diligent exclusion of NF2 is critical. Given the high likelihood of eventually requiring intervention and known adverse effects of SRS, microsurgery remains the preferred treatment. However, observation can be considered in select situations.
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Affiliation(s)
- Nikitha Kosaraju
- Division of Otology/Neurotology, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, Stanford, CA, 94305-5739, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lindsay S Moore
- Division of Otology/Neurotology, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, Stanford, CA, 94305-5739, USA
| | - Jip Y Mulders
- Division of Otology/Neurotology, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, Stanford, CA, 94305-5739, USA
- Leiden University Medical Center, Leiden, The Netherlands
| | - Nikolas H Blevins
- Division of Otology/Neurotology, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, Stanford, CA, 94305-5739, USA.
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Stankovic KM, Batts S, Welling DB, Vasilijic S. Immune Profiling of Secreted Factors from Human Vestibular Schwannoma Cells and Tumor-associated Macrophages. Laryngoscope 2024; 134 Suppl 5:S1-S14. [PMID: 37776249 DOI: 10.1002/lary.31067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/27/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES This study compared the immune-related secretory capacity of human vestibular schwannoma (VS) and tumor-assisted macrophages (TAMs) with their normal counterparts (Schwann cells [SC] and peripheral blood monocyte-derived macrophages [Mo-MFs], respectively), and examined relationships with presurgical hearing and tumor size. METHODS VS tumors (n = 16), auditory nerve (n = 1), blood (n = 9), and great auricular nerves (n = 3) were used. SCs (S100B+ ) and TAMs (CD68+ ) were isolated from VS tissue for culture. The secreted levels of 65 immune-related factors were measured and compared using unpaired t-tests with Welch correction (schwannoma vs. SCs) or Mann-Whitney tests (TAMs and Mo-MFs). Associations between factor concentration and word recognition (WR), pure-tone average (PTA), and tumor size were evaluated with Spearman correlation. RESULTS Secreted factors with significantly higher concentrations in schwannoma versus SC supernatants included IL-2 and BAFF, whereas MMP-1, IL-6, FGF-2, VEGF-A, MIP-3α, and GRO-α concentrations were significantly higher in TAMs versus Mo-MFs (all p < 0.05). Worse WR was significantly associated with higher secretion of fractalkine, eotaxin-3, CD30, and IL-16 by VS cells; IP-10, eotaxin-3, multiple interleukins, GM-CSF, SCF, and CD30 by TAMs; and TNF-α and MIP-1α by Mo-MFs (all p < 0.05). Worse PTA was significantly correlated with higher secretion of IL-16 by VS cells (p < 0.05). Larger tumor size was significantly correlated with higher secretion of eotaxin by VS cells, and of IL-7, IL-21, and LIF by TAMs (all p = 0.017). CONCLUSIONS Differential secretion of immune-related factors was observed in schwannoma versus normal SCs and in TAMs versus Mo-MFs, some of which were correlated with worse hearing and larger VS tumors. LEVEL OF EVIDENCE N/A Laryngoscope, 134:S1-S14, 2024.
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Affiliation(s)
- Konstantina M Stankovic
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
- Wu Tsai Neuroscience Institute, Stanford University, Palo Alto, California, U.S.A
- Department of Otolaryngology-Head and Neck Surgery at Massachusetts Eye and Ear and, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Shelley Batts
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - D Bradley Welling
- Department of Otolaryngology-Head and Neck Surgery at Massachusetts Eye and Ear and, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sasa Vasilijic
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
- Department of Otolaryngology-Head and Neck Surgery at Massachusetts Eye and Ear and, Harvard Medical School, Boston, Massachusetts, U.S.A
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Ben-Harosh L, Barker-Collo S, Nowacka A, Garrett J, Miles A. Quality of life and broader experiences of those with acoustic neuroma: a mixed methods approach. BRAIN IMPAIR 2024; 25:IB23072. [PMID: 38566292 DOI: 10.1071/ib23072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 04/04/2024]
Abstract
Background Acoustic neuromas (ANs) are consistently associated with decreased quality of life (QOL) related to the physical and psychosocial impacts of symptoms experienced from the tumour and its treatment. This study explored patient-reported experiences of ANs in New Zealand, with a focus on the impact on QOL and the provision of information, support and services. Methods A mixed methods approach was taken, conducting an online community survey that included the Penn Acoustic Neuroma Quality of Life Scale (N = 52). Those who indicated interest were offered semi-structured interviews after the survey (N = 17), which were analysed using content analysis. Results A negative impact on QOL was found, highlighting five key themes in the experiences of people: (1) ongoing physical, social and psychological impacts; (2) information and support from the medical system; (3) autonomy and decision-making; (4) the importance of peer support; and (5) remaining positive - life goes on. Conclusions Our findings indicate areas for improvement that may benefit people's healthcare experience and QOL. Both quantitative and qualitative results identified gaps associated with person-centred care and the need for information, education, emotional support and access to services. Recommendations include a need for more information (verbal and written) during all stages of diagnosis and treatment, shared decision-making and increased access to allied health, including psychological services and support groups.
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Affiliation(s)
- Lior Ben-Harosh
- School of Psychology, The University of Auckland, New Zealand
| | | | - Alicja Nowacka
- School of Psychology, The University of Auckland, New Zealand
| | - Joanne Garrett
- School of Psychology, The University of Auckland, New Zealand
| | - Anna Miles
- School of Psychology, The University of Auckland, New Zealand
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Fujita T, Seist R, Kao SY, Soares V, Panano L, Khetani RS, Landegger LD, Batts S, Stankovic KM. miR-431 secreted by human vestibular schwannomas increases the mammalian inner ear's vulnerability to noise trauma. Front Neurol 2023; 14:1268359. [PMID: 37885485 PMCID: PMC10598552 DOI: 10.3389/fneur.2023.1268359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Vestibular schwannoma (VS) is an intracranial tumor that arises on the vestibular branch of cranial nerve VIII and typically presents with sensorineural hearing loss (SNHL). The mechanisms of this SNHL are postulated to involve alterations in the inner ear's microenvironment mediated by the genetic cargo of VS-secreted extracellular vesicles (EVs). We aimed to identify the EV cargo associated with poor hearing and determine whether its delivery caused hearing loss and cochlear damage in a mouse model in vivo. Methods VS tissue was collected from routinely resected tumors of patients with good (VS-GH) or poor (VS-PH) pre-surgical hearing measured via pure-tone average and word recognition scores. Next-generation sequencing was performed on RNA isolated from cultured primary human VS cells and EVs from VS-conditioned media, stratified by patients' hearing ability. microRNA expression levels were compared between VS-PH and VS-GH samples to identify differentially expressed candidates for packaging into a synthetic adeno-associated viral vector (Anc80L65). Viral vectors containing candidate microRNA were infused to the semicircular canals of mice to evaluate the effects on hearing, including after noise exposure. Results Differentially expressed microRNAs included hsa-miR-431-5p (enriched in VS-PH) and hsa-miR-192-5p (enriched in VS-GH). Newborn mice receiving intracochlear injection of viral vectors over-expressing hsa-miR-431-GFP, hsa-miR-192-GFP, or GFP only (control) had similar hearing 6 weeks post-injection. However, after acoustic trauma, the miR-431 group displayed significantly worse hearing, and greater loss of synaptic ribbons per inner hair cell in the acoustically traumatized cochlear region than the control group. Conclusion Our results suggest that miR-431 contributes to VS-associated hearing loss following cochlear stress. Further investigation is needed to determine whether miR-431 is a potential therapeutic target for SNHL.
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Affiliation(s)
- Takeshi Fujita
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| | - Richard Seist
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| | - Shyan-Yuan Kao
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| | - Vitor Soares
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| | - Lorena Panano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Radhika S. Khetani
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lukas D. Landegger
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| | - Shelley Batts
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Konstantina M. Stankovic
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
- Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA, United States
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Hosoya M, Nagaoka Y, Wakabayashi T, Shimanuki MN, Nishiyama T, Ueno M, Ozawa H, Oishi N. A novel intraoperative continuous monitoring method combining dorsal cochlear nucleus action potentials monitoring with auditory nerve test system. J Otolaryngol Head Neck Surg 2023; 52:67. [PMID: 37803428 PMCID: PMC10557301 DOI: 10.1186/s40463-023-00671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
Highly accurate real-time cochlear nerve monitoring to preserve cochlear nerve function is essential for simultaneous cochlear implantation and ipsilateral vestibular schwannoma resection. In the present study, we developed a novel real-time monitoring system that combines dorsal cochlear nucleus action potential monitoring with intracochlear stimulating electrodes (Auditory Nerve Test System, ANTS). We used this system for a case with vestibular schwannoma resection via the translabyrinthine approach. The monitoring system developed in this study detected highly reliable evoked potentials from the cochlear nerve every two seconds continuously during tumor resection. Near-total tumor resection was achieved, and cochlear implantation was performed successfully after confirming the preservation of cochlear nerve function in a case. The patient's hearing was well compensated by cochlear implantation after surgery. Our novel method continuously achieved real-time monitoring of the cochlear nerve every two seconds during vestibular schwannoma resection. The usefulness of this monitoring system for simultaneous tumor resection and cochlear implantation was demonstrated in the present case. The system developed in this study is compatible with continuous facial nerve monitoring. This highly accurate and novel monitoring method will broaden the number of candidates for this type of surgery in the future.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuriko Nagaoka
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takeshi Wakabayashi
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Marie N Shimanuki
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takanori Nishiyama
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masafumi Ueno
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroyuki Ozawa
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naoki Oishi
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Di Pasquale Fiasca VM, Sorrentino F, Conti M, De Lucia G, Trevisi P, de Filippis C, Zanoletti E, Brotto D. Hearing Aid in Vestibular-Schwannoma-Related Hearing Loss: A Review. Audiol Res 2023; 13:627-635. [PMID: 37622930 PMCID: PMC10451483 DOI: 10.3390/audiolres13040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/21/2023] [Accepted: 04/13/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Several types of hearing aids are available for the rehabilitation of vestibular-schwannoma (VS)-related hearing loss. There is a lack of recently published papers regarding this theme. The aim of the present work is to organize current knowledge. (2) Methods: A review of the literature regarding the topics "vestibular schwannoma", "hearing loss", and "hearing aid" was performed. Nineteen studies were thus considered. (3) Results: Conventional hearing aids, contralateral routing of signal (CROS) aids, bone anchored hearing aids (BAHA), and others are available options for hearing rehabilitation in VS patients. The speech discrimination score (SDS) is considered the best measure to assess candidacy for rehabilitation with hearing aids. The best hearing rehabilitative conditions in VS patients when using conventional hearing aid devices are a mild-moderate hearing loss degree with good word recognition (more than 50% SDS). CROS-Aid and BAHA are reported to be beneficial. CROS-Aid expands on the area of receiving hearing. BAHA aids use direct bone-conduction stimulation. Unfortunately, there are no available studies focused specifically on VS patients that compare CROS and BAHA technologies. (4) Conclusions: Hearing aids, CROS, and BAHA are viable options for rehabilitating hearing impairment in VS, but require an accurate case-by-case audiological evaluation for rehabilitating hearing impairment in VS. Further studies are needed to prove if what is currently known about similar hearing illnesses can be confirmed, particularly in the case of VS.
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Affiliation(s)
- Valerio Maria Di Pasquale Fiasca
- Section of Otolaryngology, Otolaryngology Unit, Department of Neurosciences, University of Padova, Via 5 Giustiniani 2, 35128 Padua, Italy
| | - Flavia Sorrentino
- Section of Otolaryngology, Otolaryngology Unit, Department of Neurosciences, University of Padova, Via 5 Giustiniani 2, 35128 Padua, Italy
| | - Martina Conti
- Section of Otolaryngology, Otolaryngology Unit, Department of Neurosciences, University of Padova, Via 5 Giustiniani 2, 35128 Padua, Italy
| | - Giulia De Lucia
- Section of Otolaryngology, Otolaryngology Unit, Department of Neurosciences, University of Padova, Via 5 Giustiniani 2, 35128 Padua, Italy
| | - Patrizia Trevisi
- Section of Otolaryngology, Otolaryngology Unit, Department of Neurosciences, University of Padova, Via 5 Giustiniani 2, 35128 Padua, Italy
| | - Cosimo de Filippis
- Audiology Unit, Department of Neuroscience DNS, University of Padova, 31100 Treviso, Italy
| | - Elisabetta Zanoletti
- Section of Otolaryngology, Otolaryngology Unit, Department of Neurosciences, University of Padova, Via 5 Giustiniani 2, 35128 Padua, Italy
| | - Davide Brotto
- Section of Otolaryngology, Otolaryngology Unit, Department of Neurosciences, University of Padova, Via 5 Giustiniani 2, 35128 Padua, Italy
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Mankekar G, Holmes S. Hearing Rehabilitation in Vestibular Schwannoma. Audiol Res 2023; 13:357-366. [PMID: 37218842 DOI: 10.3390/audiolres13030031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/13/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
The most common complaint among patients with vestibular schwannoma (VS) is hearing loss. This significantly affects the quality of life before, during, and after treatment for patients with VS. Untreated hearing loss in VS patients may even lead to depression and feelings of social isolation. A variety of devices are available for hearing rehabilitation for patients with vestibular schwannoma. These include contralateral routing of hearing signals (CROSs), bone-anchored hearing devices, auditory brainstem implants (ABI), and cochlear implants. In the United States, ABI is approved for patients 12 years of age and older with neurofibromatosis type 2. In the past few years, cochlear implantation has been offered simultaneously or sequentially with tumor resection or irradiation, or even to patients whose VS have been monitored with serial imaging. However, determining the functional integrity of the auditory nerve in patients with vestibular schwannoma is a challenge. This review article consists of (1) the pathophysiology of vestibular schwannoma (VS), (2) hearing loss in VS, (3) treatment of VS and associated hearing loss, (4) options for auditory rehabilitation in patients with VS with their individual benefits and limitations, and (5) challenges in hearing rehabilitation in this cohort of patients to determine auditory nerve functionality. (6) Future directions.
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Affiliation(s)
- Gauri Mankekar
- Department of Otolaryngology, Louisiana State Health University Sciences Center, Shreveport, LA 71103, USA
| | - Sean Holmes
- Department of Otolaryngology, Cox Health Medical Group, Springfield, MO 35807, USA
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Young K, Grewal MR, Diaz RC, Wu AW, Miller ME. Cochlear Implantation after Stereotactic Radiosurgery for Vestibular Schwannoma: Initial Hearing Improvement and Longevity of Hearing Restoration. Otol Neurotol 2023; 44:201-208. [PMID: 36728114 DOI: 10.1097/mao.0000000000003815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The following research question was asked: In patients with vestibular schwannoma (VS) that underwent stereotactic radiosurgery (SRS) and cochlear implantation, were improvements in hearing function observed, and what was the cochlear implant (CI) failure rate of in these patients? DATA SOURCES PubMed/Medline, CINAHL (EBSCOhost), and Web of Science articles without restrictions on publication dates were searched. STUDY SELECTION Inclusion criteria required that the article was a report, a series, or a retrospective review with individual case data available. Non-English articles were excluded. Inclusion criteria required that patients were with VS and underwent subsequent SRS and cochlear implantation. Patients receiving microsurgery or stereotactic radiotherapy on the ipsilateral ear were excluded from this study. DATA EXTRACTION Included studies were evaluated using full-text evaluation, and data on study characteristics (author names, gender), clinical data (syndromic information, SRS modality), hearing outcomes, and device failure were extracted. DATA SYNTHESIS Means and averages were obtained for all continuous variables. Percentages were ascertained for all categorical variables. CONCLUSIONS The majority of patients undergoing CI placement in VS treated with SRS achieved open-set speech perception (79.2%) or environmental sound awareness (6.8%). Twelve implants (20.3%) failed. Three patterns were associated with failure: 1) immediate-onset failure, 2) initial benefit with delayed failure, 3) poor local control with device explantation.
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Affiliation(s)
| | - Maeher R Grewal
- Department of Otolaryngology-Head and Neck Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Rodney C Diaz
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mia E Miller
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Understanding the Molecular Mechanism of Vestibular Schwannoma for Hearing Preservation Surgery: Otologists’ Perspective from Bedside to Bench. Diagnostics (Basel) 2022; 12:diagnostics12051044. [PMID: 35626200 PMCID: PMC9140016 DOI: 10.3390/diagnostics12051044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023] Open
Abstract
Vestibular schwannoma is a clinically benign schwannoma that arises from the vestibulocochlear nerve that causes sensorineural hearing loss. This tumor is clinically and oncologically regarded as a benign tumor as it does not metastasize or invade surrounding tissues. Despite being a benign tumor, its management is difficult and controversial due to the potential serious complications, such as irreversible sensorineural hearing loss, of current interventions. Therefore, preventing hearing loss due to the natural course of the disease and complications of surgery is a challenging issue for an otologist. Improvements have been reported recently in the treatment of vestibular schwannomas. These include advances in intraoperative monitoring systems for vestibular schwannoma surgery where the risk of hearing loss as a complication is decreased. Precise genomic analysis of the tumor would be helpful in determining the characteristics of the tumor for each patient, leading to a better hearing prognosis. These procedures are expected to help improve the treatment of vestibular schwannomas. This review summarizes recent advances in vestibular schwannoma management and treatment, especially in hearing preservation. In addition, recent advances in the understanding of the molecular mechanisms underlying vestibular schwannomas and how these advances can be applied in clinical practice are outlined and discussed, respectively. Moreover, the future directions from the bedside to the bench side are presented from the perspective of otologists.
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11
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Voelker J, Voelker C, Engert J, Goemann N, Hagen R, Rak K. Spontaneous Calcium Oscillations through Differentiation: A Calcium Imaging Analysis of Rat Cochlear Nucleus Neural Stem Cells. Cells 2021; 10:2802. [PMID: 34685782 PMCID: PMC8534573 DOI: 10.3390/cells10102802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/14/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022] Open
Abstract
Causal therapies for the auditory-pathway and inner-ear diseases are still not yet available for clinical application. Regenerative medicine approaches are discussed and examined as possible therapy options. Neural stem cells could play a role in the regeneration of the auditory pathway. In recent years, neural stem and progenitor cells have been identified in the cochlear nucleus, the second nucleus of the auditory pathway. The current investigation aimed to analyze cell maturation concerning cellular calcium activity. Cochlear nuclei from PND9 CD rats were microscopically dissected and propagated as neurospheres in free-floating cultures in stem-cell medium (Neurobasal, B27, GlutaMAX, EGF, bFGF). After 30 days, the dissociation and plating of these cells took place under withdrawal of the growth factors and the addition of retinoic acid, which induces neural cell differentiation. Calcium imaging analysis with BAPTA-1/Oregon Green was carried out at different times during the differentiation phase. In addition, the influence of different voltage-dependent calcium channels was analyzed through the targeted application of inhibitors of the L-, N-, R- and T-type calcium channels. For this purpose, comparative examinations were performed on CN NSCs, and primary CN neurons. As the cells differentiated, a significant increase in spontaneous neuronal calcium activity was demonstrated. In the differentiation stage, specific frequencies of the spontaneous calcium oscillations were measured in different regions of the individual cells. Initially, the highest frequency of spontaneous calcium oscillations was ascertainable in the maturing somata. Over time, these were overtaken by calcium oscillations in the axons and dendrites. Additionally, in the area of the growth cones, an increasing activity was determined. By inhibiting voltage-dependent calcium channels, their expression and function in the differentiation process were confirmed. A comparable pattern of maturation of these channels was found in CN NSCs and primary CN neurons. The present results show that neural stem cells of the rat cochlear nucleus differentiated not only morphologically but also functionally. Spontaneous calcium activities are of great relevance in terms of neurogenesis and integration into existing neuronal structures. These functional aspects of neurogenesis within the auditory pathway could serve as future targets for the exogenous control of neuronal regeneration.
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Affiliation(s)
- Johannes Voelker
- Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, Department of Oto-Rhino-Laryngology, University of Wuerzburg Josef-Schneider-Strasse 11, D-97080 Wuerzburg, Germany; (C.V.); (J.E.); (N.G.); (R.H.); (K.R.)
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Longino ES, Manzoor NF, Cass ND, Tawfik KO, Bennett ML, O'Malley MR, Haynes DS, Perkins EL. Cochlear Implantation Outcomes in Observed Vestibular Schwannoma: A Preliminary Report. Otolaryngol Head Neck Surg 2021; 167:149-154. [PMID: 34546801 DOI: 10.1177/01945998211045903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Over the last decade there has been a trend toward observation for small nongrowing vestibular schwannoma (VS). Even without tumor growth, patients commonly experience ipsilateral hearing decline, and hearing rehabilitation remains challenging. This study analyzes hearing and speech performance outcomes after cochlear implantation (CI) in observed VS. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. METHODS Chart review was used to include patients with observed VS who had undergone ipsilateral CI, pre- and postimplantation audiometry, and speech performance. Tumor size pre- and postimplantation was measured with volumetric analysis. RESULTS Seven patients with ipsilateral VS and CI were identified. Preimplantation tumor volume was 0.11 to 1.02 cm3. Five subjects were implanted with a straight electrode and two with a perimodiolar electrode. The average preimplant pure tone average was 91.3 dB (range, 80-117 dB) and 61.2 dB (range, 12-118 dB) for the implanted and nonimplanted ears, respectively. In all subjects with at least 1 year of listening experience (n = 6), consonant-nucleus-consonant word scores improved at 6 months and 1 year in the CI-alone and bimodal listening conditions. AzBio scores in quiet also improved at 6 months and 1 year. Of subjects with serial pre- and postoperative magnetic resonance imaging, volumetric analysis demonstrated no tumor growth. CONCLUSION Our results demonstrate that CI is a successful option for subjects with small nongrowing VS. All subjects had improved performance postimplantation. VS may continue to be observed with serial magnetic resonance imaging given increasing conditionality among CI manufacturers and ability to assess cerebellopontine angle extension despite implant artifact.
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Affiliation(s)
- Elizabeth S Longino
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nathan D Cass
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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Affiliation(s)
- Matthew L Carlson
- From the Departments of Otolaryngology-Head and Neck Surgery and Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Michael J Link
- From the Departments of Otolaryngology-Head and Neck Surgery and Neurologic Surgery, Mayo Clinic, Rochester, MN
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Worrell SL, Kirschner ML, Shatz RS, Sengupta S, Erickson MG. Interdisciplinary Approaches to Survivorship with a Focus on the Low-grade and Benign Brain Tumor Populations. Curr Oncol Rep 2021; 23:19. [PMID: 33471214 PMCID: PMC7817573 DOI: 10.1007/s11912-020-01004-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW "Brain tumor is a bump in the road." Sheryl Crow a famous singer was quoted talking about her meningioma, a benign brain tumor that caused her to forget her lyrics. In this review, we focus on low-grade gliomas in adults and benign brain tumors, such as meningiomas, vestibular schwannomas, and pituitary tumors, since these individuals survive a long time and morbidity is a major issue. RECENT FINDINGS As per the NCI dictionary definition, cancer survivorship focuses on the health and well-being of a person with cancer from the time of diagnosis until the end of life. This includes the physical, mental, emotional, social, and financial effects of cancer that begin at diagnosis and continue through treatment and beyond. The survivorship experience also includes issues related to follow-up care (including regular health and wellness checkups), late effects of treatment, cancer recurrence, second cancers, and quality of life. Family members, friends, and caregivers are also considered part of the survivorship experience (NCI Dictionary: https://www.cancer.gov/publications/dictionaries/cancer-terms ).
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Affiliation(s)
- Stacey L Worrell
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, 234 Goodman St, Cincinnati, OH, 45219, USA
| | | | - Rhonna S Shatz
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, 234 Goodman St, Cincinnati, OH, 45219, USA
| | - Soma Sengupta
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, 234 Goodman St, Cincinnati, OH, 45219, USA.
| | - Melissa G Erickson
- Department of Family Medicine, University of Cincinnati, Cincinnati, OH, USA
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Macielak RJ, Marinelli JP, Spear SA, Hahs-Vaughn DL, Link MJ, Nye C, Carlson ML. Hearing Status and Aural Rehabilitative Profile of 878 Patients With Sporadic Vestibular Schwannoma. Laryngoscope 2020; 131:1378-1381. [PMID: 33296080 DOI: 10.1002/lary.29315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/30/2020] [Accepted: 11/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To examine the hearing status and aural rehabilitative profile in a national cohort of patients with sporadic vestibular schwannoma (VS). STUDY DESIGN Cross-sectional survey METHODS: A cross-sectional survey of Acoustic Neuroma Association members diagnosed with sporadic VS was performed from February 2017 through January 2019. Self-reported results were used to determine the aural rehabilitative profile of respondents. RESULTS Among survey respondents, 62.2% (546/878) were not using any hearing-assistive device at time of survey. For the 37.8% (332/878) that were utilizing hearing-assistive devices, 32.8% (109/332) reported using a behind-the-ear hearing aid, 23.8% (79/332) used a contralateral routing of signal (CROS) hearing aid, and 21.7% (72/332) used a bone conduction device. Notably, 41.9% (278/663) of patients who previously underwent tumor treatment reported utilizing a hearing rehabilitation device at some point during VS management compared to 27.0% (58/215) of those undergoing observation with serial imaging (P < .001). Of 275 patients with functional hearing in the ipsilateral ear, 26.5% (73/275) reported having used at least one type of hearing device; 24.0% (66/275) reported use of a conventional hearing aid, 0.7% (2/275) a CROS aid, and 0.4% (1/275) a bone conduction device. Among respondents reporting ipsilateral nonfunctional hearing, 44.9% (258/575) reported having used at least one type of hearing device; 13.0% (75/575) a CROS aid, and 12.3% (71/575) a bone conduction device. CONCLUSIONS Even among a cohort with presumably elevated literacy surrounding hearing rehabilitation options, few patients with a history of unilateral vestibular schwannoma ultimately use hearing assistive devices long-term, suggesting that most patients sufficiently adjust to unilateral hearing loss or are unsatisfied with the benefits achieved with current device options. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1378-1381, 2021.
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Affiliation(s)
- Robert J Macielak
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - Samuel A Spear
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - Debbie L Hahs-Vaughn
- Department of Learning Sciences and Educational Research, University of Central Florida, Orlando, Florida, U.S.A
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Chad Nye
- Acoustic Neuroma Association, Cumming, Georgia, U.S.A
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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16
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Mahboubi H, Slattery WH, Mehta GU, Lekovic GP. Options and strategies for hearing restoration in pediatric neurofibromatosis type 2. Childs Nerv Syst 2020; 36:2481-2487. [PMID: 32564156 DOI: 10.1007/s00381-020-04721-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/02/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE In this article, we will review the mechanisms and natural history of hearing loss in neurofibromatosis type 2 (NF2) and discuss the hearing outcomes with different rehabilitation options. METHODS Review of the published literature. RESULTS NF2 is a rare autosomal dominant syndrome characterized by vestibular schwannomas and other intracranial and spinal tumors. Bilateral vestibular schwannomas are the hallmark of the disease which occur in 90 to 95% of the patients. As a result, hearing loss will eventually occur in almost all NF2 patients. Deafness can occur from tumor progression or from treatment of vestibular schwannomas and is among the most debilitating aspects of NF2. A number of surgical and non-surgical rehabilitation options are available for these patients including cochlear and auditory brainstem implants. The audiologic outcomes with surgical rehabilitation options have been variable but most patients are able to achieve sound awareness and benefit from auditory cues in lip reading. CONCLUSION Early identification and treatment of NF2 patients can help in achieving better hearing outcomes in the pediatric population. An increasing number of NF2 patients are receiving open set word understanding with refinement in surgical techniques.
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Affiliation(s)
- Hossein Mahboubi
- Division of Neurotology (HM and WHS) and Division of Neurosurgery (GUM and GPL), House Ear Institute, 2100 W 3rd Street, Suite 111, Los Angeles, CA, 90057, USA
| | - William H Slattery
- Division of Neurotology (HM and WHS) and Division of Neurosurgery (GUM and GPL), House Ear Institute, 2100 W 3rd Street, Suite 111, Los Angeles, CA, 90057, USA
| | - Gautam U Mehta
- Division of Neurotology (HM and WHS) and Division of Neurosurgery (GUM and GPL), House Ear Institute, 2100 W 3rd Street, Suite 111, Los Angeles, CA, 90057, USA
| | - Gregory P Lekovic
- Division of Neurotology (HM and WHS) and Division of Neurosurgery (GUM and GPL), House Ear Institute, 2100 W 3rd Street, Suite 111, Los Angeles, CA, 90057, USA.
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