1
|
You N, Zhang J, Zhang D, Zhao Y, Zhang J, Xu B. Predictive factors of tinnitus after vestibular schwannoma surgery: a case-control study. Chin Neurosurg J 2024; 10:10. [PMID: 38566173 PMCID: PMC10988867 DOI: 10.1186/s41016-024-00363-6] [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: 12/13/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Tinnitus is very common in patients with vestibular schwannoma (VS). We analyzed the related factors of tinnitus after surgery. METHODS One hundred seventy-three patients diagnosed with unilateral VS operated via the retrosigmoid approach were included in the study. All patients underwent relevant examinations and completed the THI scale before surgery and 6 months after surgery. The prognosis of tinnitus was evaluated according to the changes in THI. RESULTS Of the 129 preoperative tinnitus patients, postoperative tinnitus resolved in 12.4%, improved in 29.5%, remained unchanged in 28.6%, and worsened in 29.5%. 18.2% of 44 patients without preoperative tinnitus appeared new-onset tinnitus postoperatively. Thirty-six patients never had tinnitus. Patients with smaller tumor sizes (≤ 3 cm) were more likely to experience preoperative tinnitus. Younger patients and those with serviceable hearing preoperatively were more likely to report their tinnitus unchanged or worsened. A new onset of postoperative tinnitus in the preoperative non-tinnitus group was found in better preoperative hearing function. CONCLUSIONS In this study, 70% of patients had persistent tinnitus after vestibular schwannoma resection. The prognosis of tinnitus was influenced by age and preoperative hearing function. Tinnitus is a bothersome symptom and is often underestimated by doctors. Assessment of tinnitus is mandatory during the management of vestibular schwannoma.
Collapse
Affiliation(s)
- Na You
- Medical School of Chinese PLA, Beijing, China
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jiashu Zhang
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Ding Zhang
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yue Zhao
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jun Zhang
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bainan Xu
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| |
Collapse
|
2
|
Doerfer KW, Fritz CG, Porps SL, Hong RS, Jacob JT, Babu SC. Twelve-Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation. Otolaryngol Head Neck Surg 2023. [PMID: 36939583 DOI: 10.1002/ohn.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Audiometric outcomes at 12 months following simultaneous translabyrinthine (TL) resection of vestibular schwannoma (VS) and cochlear implantation (CI). STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. METHODS Adult patients undergoing TL resection of sporadic, unilateral VS ≤ 2 cm were prospectively enrolled. Preoperative testing included binaural AZBio in noise and quiet and unilateral Consonant-Nucleus-Consonant (CNC). Tinnitus Handicap Index (THI) and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires were also completed. Patients underwent TL resection with simultaneous CI. The preoperative test battery was repeated at 1, 3, 6, and 12 months after activation. Statistical analysis was performed to characterize short-term outcomes (preoperative to 3 months), longer-term outcomes (3-12 months), and overall changes during the preoperative to 12-month period. RESULTS AZBio, CNC, and THI improved at 3 months with no significant changes thereafter and showed durable improvement at 12 months compared to preoperative testing. While SSQ did not improve at 12 months, a subset of patients showed either recovery or improvement of SSQ-spatial subscores. Patients with cerebellopontine angle tumors had poorer performance, although the impact of tumor size and location could not be deduced based on the small sample size. CONCLUSION Patients undergoing simultaneous CI and TL resection of VS had durable improvements in speech perception and tinnitus severity 12 months following surgery. Subjective improvements in localization were not observed. Additional studies are needed to determine which VS patients are optimal candidates for CI.
Collapse
Affiliation(s)
- Karl W Doerfer
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christian G Fritz
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Sandra L Porps
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Robert S Hong
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Jeffrey T Jacob
- Division of Skull Base Surgery, Michigan Head and Spine Institute, Southfield, Michigan, USA
| | - Seilesh C Babu
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| |
Collapse
|
3
|
Conway RM, Tu NC, Sioshansi PC, Porps SL, Schutt CA, Hong RS, Jacob JT, Babu SC. Early Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation. Laryngoscope 2021; 131:E2312-E2317. [PMID: 33851722 DOI: 10.1002/lary.29436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS Hearing rehabilitation after translabyrinthine resection of a vestibular schwannoma (VS) has largely been based on the transfer of acoustic stimulus to the contralateral ear, typically through a contralateral routing of signal hearing aid or bone-anchored hearing aid (BAHA). Cochlear implant, either as a subsequent surgery or simultaneously, has become a more common treatment option; however, there is still relatively limited data available on its success. The purpose of this study is to evaluate the early outcomes of simultaneous cochlear implantation in patients with sporadic VS undergoing translabyrinthine resection. STUDY DESIGN Prospective, nonrandomized study. METHODS A prospective study of nonrandomized patients was completed at a tertiary care neurotology center. Audiologic outcomes, primarily based on AzBIO in quiet and background noise, as well as consonant-nucleus-consonant (CNC) testing of the affected ears were utilized. Tinnitus, dizziness, and spatial hearing questionnaries were also completed. Audiologic outcomes and questionnaires were compared between the pre- and postoperative groups. RESULTS Ten patients were included in the study with 3 month follow-up data. There was statistically significant improvement in AzBO with +10 and +5 signal to noise ratio and in quiet, as well as in CNC testing (P < .05). There was a significant improvement in Tinnitus Handicap Inventory between the two groups. CONCLUSIONS Simultaneous cochlear implantation is a viable treatment for hearing loss after translabyrinthine approach to VS. These patients have improved hearing in background noise and tinnitus compared to their preoperative state. Further prognostic data are required to determine which patients are the best candidates. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2312-E2317, 2021.
Collapse
Affiliation(s)
- Robert M Conway
- Department of Otolaryngology-Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, Michigan, USA
| | - Nathan C Tu
- Michigan Ear Institute, Farmington Hills, Michigan, USA
| | | | | | | | - Robert S Hong
- Michigan Ear Institute, Farmington Hills, Michigan, USA
| | | | | |
Collapse
|
4
|
Wang JJ, Feng YM, Wang H, Wu YQ, Shi HB, Chen ZN, Yin SK. Changes in tinnitus after vestibular schwannoma surgery. Sci Rep 2019; 9:1743. [PMID: 30742012 PMCID: PMC6370768 DOI: 10.1038/s41598-019-38582-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/03/2019] [Indexed: 01/18/2023] Open
Abstract
We designed a prospective study to evaluate changes in tinnitus after vestibular schwannoma (VS) surgery. Subjects included 41 patients who were diagnosed with a VS and underwent translabyrinthine microsurgery (TLM) between January 2015 and May 2016. All patients underwent related examinations and were asked to answer the Tinnitus Handicap Inventory (THI) scale and a visual analog scale (VAS) of tinnitus severity both pre- and postoperatively. Of the 41 patients, 31 (75.6%) suffered from tinnitus before surgery. Microsurgery was associated with an overall decrease in tinnitus (p < 0.001). There was a significant improvement in THI and VAS scores after surgery (p = 0.001 and p = 0.005, respectively). The decrease in THI scores in the low-frequency group was significantly larger than that of the mid- and high-frequency groups after surgery (p = 0.034 and p = 0.001, respectively). The loudness of tinnitus decreased significantly after surgery (p = 0.031). Tinnitus in patients with VS improved after TLM. Patients with mid-/high-frequency tinnitus and louder tinnitus preoperatively seemed to have a worse prognosis than those with low-frequency and quieter tinnitus.
Collapse
Affiliation(s)
- Jing-Jing Wang
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China
| | - Yan-Mei Feng
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China
| | - Hui Wang
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China
| | - Ya-Qin Wu
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China
| | - Hai-Bo Shi
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China
| | - Zheng-Nong Chen
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.
| | - Shan-Kai Yin
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.
| |
Collapse
|
5
|
|
6
|
Naros G, Sandritter J, Liebsch M, Ofori A, Rizk AR, Del Moro G, Ebner F, Tatagiba M. Predictors of Preoperative Tinnitus in Unilateral Sporadic Vestibular Schwannoma. Front Neurol 2017; 8:378. [PMID: 28824535 PMCID: PMC5541055 DOI: 10.3389/fneur.2017.00378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/17/2017] [Indexed: 12/12/2022] Open
Abstract
Objective Nearly two-thirds of patients with vestibular schwannoma (VS) are reporting a significantly impaired quality of life due to tinnitus. VS-associated tinnitus is attributed to an anatomical and physiological damage of the hearing nerve by displacing growth of the tumor. In contrast, the current pathophysiological concept of non-VS tinnitus hypothesizes a maladaptive neuroplasticity of the central nervous system to a (hidden) hearing impairment resulting in a subjective misperception. However, it is unclear whether this concept fits to VS-associated tinnitus. This study aims to determine the clinical predictors of VS-associated tinnitus to ascertain the compatibility of both pathophysiological concepts. Methods This retrospective study includes a group of 478 neurosurgical patients with unilateral sporadic VS evaluated preoperatively regarding the occurrence of ipsilateral tinnitus depending on different clinical factors, i.e., age, gender, tumor side, tumor size (T1–T4 according to the Hannover classification), and hearing impairment (Gardner–Robertson classification, GR1–5), using a binary logistic regression. Results 61.8% of patients complain about a preoperative tinnitus. The binary logistic regression analysis identified male gender [OR 1.90 (1.25–2.75); p = 0.002] and hearing impairment GR3 [OR 1.90 (1.08–3.35); p = 0.026] and GR4 [OR 8.21 (2.29–29.50); p = 0.001] as positive predictors. In contrast, patients with large T4 tumors [OR 0.33 (0.13–0.86); p = 0.024] and complete hearing loss GR5 [OR 0.36 (0.15–0.84); p = 0.017] were less likely to develop a tinnitus. Yet, 60% of the patients with good clinical hearing (GR1) and 25% of patients with complete hearing loss (GR5) suffered from tinnitus. Conclusion These data are good accordance with literature about non-VS tinnitus indicating hearing impairment as main risk factor. In contrast, complete hearing loss appears a negative predictor for tinnitus. For the first time, these findings indicate a non-linear relationship between hearing impairment and tinnitus in unilateral sporadic VS. Our results suggest a similar pathophysiology in VS-associated and non-VS tinnitus.
Collapse
Affiliation(s)
- Georgios Naros
- Department of Neurosurgery, Eberhard Karls University, Tuebingen, Germany
| | - Joey Sandritter
- Department of Neurosurgery, Eberhard Karls University, Tuebingen, Germany
| | - Marina Liebsch
- Department of Neurosurgery, Eberhard Karls University, Tuebingen, Germany
| | - Alex Ofori
- Department of Neurosurgery, Eberhard Karls University, Tuebingen, Germany
| | - Ahmed R Rizk
- Department of Neurosurgery, Eberhard Karls University, Tuebingen, Germany
| | - Giulia Del Moro
- Department of Neurosurgery, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery, University of Padova, Padova, Italy
| | - Florian Ebner
- Department of Neurosurgery, Eberhard Karls University, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University, Tuebingen, Germany
| |
Collapse
|