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Ölander C, Feychting M, Eriksson PO, Laurell G, Talbäck M, Ek S. Fall-related injury among patients with vestibular schwannoma. PLoS One 2024; 19:e0304184. [PMID: 38875269 PMCID: PMC11178211 DOI: 10.1371/journal.pone.0304184] [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: 01/19/2024] [Accepted: 05/06/2024] [Indexed: 06/16/2024] Open
Abstract
Vestibular schwannoma can cause vestibular dysfunction; however, conflicting evidence exists regarding whether this affects the incidence of fall-related injuries in this patient population. This matched cross-sectional and cohort study assess the risk of fall-related injuries in patients with vestibular schwannoma. The study included patients with vestibular schwannoma treated at a tertiary referral hospital in Sweden between 1988 and 2014. Information on fall-related injuries was obtained from the National Patient Register, and matched population comparisons were randomly selected in a 1:25 ratio. Fall-related injuries occurring pre- (within 5 years before the diagnosis of vestibular schwannoma) and post-diagnostically (up to 3 years after diagnosis or intervention) were registered. The association between vestibular schwannoma and fall-related injuries was estimated using logistic regression and Cox proportional hazards analyses. We identified 1153 patients with vestibular schwannoma (569 [49%] women and 584 [51%] men), and 28815 population comparisons. Among the patients, 9% and 7% had pre- and post-diagnostic fall-related injuries, respectively, and among the comparisons, 8% and 6% had pre- and post-diagnostic fall-related injuries, respectively. There was no increased risk of pre- (OR 1.14; CI 0.92-1.41) or post-diagnostic 1 year (HR 1.16; CI 0.87-1.54) or 3 years (HR 1.11; CI 0.89-1.29) fall-related injury among the total patient cohort. In age-stratified analyses, we found an increased risk of pre-diagnostic fall-related injury among patients aged 50-69 years (OR 1.42; CI 1.10-1.88). Patients who underwent middle fossa surgery, regardless of age, had an increased risk of post-surgery fall-related injury within 3 years of follow-up (HR 2.68; CI 1.06-6.81). We conclude that patients with vestibular schwannoma have a low risk of enduring fall-related injuries. Middle-aged patients with dizziness and fall-related injuries should be considered for a vestibular clinical evaluation. Our results highlight the importance of rehabilitation in avoiding future fall-related injuries among patients undergoing middle fossa surgery.
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Affiliation(s)
- Christine Ölander
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Per Olof Eriksson
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Campbell T, Goh SJ, Wadeson AM, Freeman SR, Rutherford SA, King AT, Hammerbeck-Ward CL, Pathmanaban O, Entwistle H, Bird J, Axon PR, Moffat DA, Lloyd SK. Changes in audiovestibular handicap following treatment of vestibular schwannomas. J Laryngol Otol 2024; 138:608-614. [PMID: 38017610 PMCID: PMC11096832 DOI: 10.1017/s002221512300213x] [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: 03/15/2023] [Revised: 09/23/2023] [Accepted: 10/02/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE This study aimed to assess degree of audiovestibular handicap in patients with vestibular schwannoma. METHODS Audiovestibular handicap was assessed using the Hearing Handicap Inventory, Tinnitus Handicap Inventory and Dizziness Handicap Inventory. Patients completed questionnaires at presentation and at least one year following treatment with microsurgery, stereotactic radiosurgery or observation. Changes in audiovestibular handicap and factors affecting audiovestibular handicap were assessed. RESULTS All handicap scores increased at follow up, but not significantly. The Tinnitus Handicap Inventory and Dizziness Handicap Inventory scores predicted tinnitus and dizziness respectively. The Hearing Handicap Inventory was not predictive of hearing loss. Age predicted Tinnitus Handicap Inventory score and microsurgery was associated with a deterioration in Dizziness Handicap Inventory score. CONCLUSION Audiovestibular handicap is common in patients with vestibular schwannoma, with 75 per cent having some degree of handicap in at least one inventory. The overall burden of handicap was, however, low. The increased audiovestibular handicap over time was not statistically significant, irrespective of treatment modality.
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Affiliation(s)
- Tim Campbell
- Brighton and Sussex Medical School, Brighton, UK
| | | | - Andrea M Wadeson
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon R Freeman
- Department of Otolaryngology, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Scott A Rutherford
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrew T King
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Manchester, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Brain and Mental Health, University of Manchester, Manchester, UK
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Brain and Mental Health, University of Manchester, Manchester, UK
| | - Charlotte L Hammerbeck-Ward
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Omar Pathmanaban
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Helen Entwistle
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Judith Bird
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
| | - Patrick R Axon
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
| | - David A Moffat
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
| | - Simon K Lloyd
- Department of Otolaryngology, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
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Zhang L, Ouyang S, Chen L, Huang H, Ou Y, Tang X. Evaluation of subjective visual vertical and horizontal in patients with acoustic neuroma based on virtual reality. Front Neurosci 2023; 17:1264585. [PMID: 37954872 PMCID: PMC10639117 DOI: 10.3389/fnins.2023.1264585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Objective To investigate potential differences in absolute deviation values of subjective visual vertical and horizontal between unilateral acoustic neuroma patients and healthy young adults under varying degrees of static head tilt, as well as the impact of proprioception on these values, with the aim of determining the effect of acoustic neuroma on gravity sensory pathway function in patients. Methods We recruited 22 patients diagnosed with unilateral acoustic neuroma and 25 healthy young adults and employed virtual reality technology to assess the absolute deviation values of subjective visual vertical (SVV) and subjective visual horizontal (SVH) under eight different static tilted head positions (Head centered (0° tilt), PdP, Head tilt 15°, 30°, 45° to the left and right), then compare and analyze intergroup differences. Results In the Head-centered position, both SVV and SVH absolute deviated values were significantly higher in the AN group compared to healthy young adults. The AN group exhibited significantly higher absolute deviation values of SVV compared to the healthy group when tilting their head 30° left and right. Additionally, when tilting their heads to the right at 15° and 45° the AN group showed significant increases in SVH absolute deviated values compared to healthy adults. The SVV and SVH absolute deviation values of LAN and SAN groups did not reach statistical significance. The results of the SVV test for PDP position did not show any significant differences among all groups. However, the SVH test revealed that the absolute deviation values of the LAN group was significantly higher than that of healthy individuals. Conclusion Our study shows that the gravity sensing function of patients with unilateral acoustic neuroma is affected to different degrees, however, the degree of gravity sensing function damage of patients has little relationship with tumor size. When acoustic neuroma is larger than 2 cm, the effect of proprioception on patients' SVH outcome is noteworthy. So, we should pay attention to the postoperative follow-up of patients with acoustic neuroma and the evaluation of vestibular rehabilitation effect. Meanwhile, for patients opting for conservative treatment, it is imperative to monitor the dynamic changes in vestibular function and seize timely opportunities for intervention.
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Affiliation(s)
- Lin Zhang
- Department of Otorhinolaryngology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shunlin Ouyang
- Department of Otorhinolaryngology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Hemei Huang
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yongkang Ou
- Department of Otorhinolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Xiaowu Tang
- Department of Otorhinolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
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Park JY, Kim CH. Vestibular Schwannoma Presenting as Acute Vertigo Mimicking Vestibular Neuritis. Case Rep Neurol 2022; 14:464-468. [PMID: 36636270 PMCID: PMC9830296 DOI: 10.1159/000527989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022] Open
Abstract
Vestibular schwannoma (VS) is commonly accompanied by hearing loss, tinnitus, and dizziness and tends to be chronically progressive in nature. We report a case of VS presenting as left vestibular neuritis (VN) in a previously healthy 57-year-old patient. Right-beating horizontal-torsional spontaneous nystagmus was observed, and the bedside head impulse test revealed a left catch-up saccade. The bithermal caloric test showed left canal paresis, and pure-tone audiometry revealed an average threshold of 22.5 dB bilaterally. Brain magnetic resonance imaging (MRI) demonstrated a 0.7-cm enhancing mass in the left internal auditory canal, consistent with VS. The patient was administered with high-dose systemic corticosteroids and vestibular suppressants with antiemetic, which relieved acute vertigo. Although dizziness in VS is chronically progressive in nature, VS may present as an acute vestibular syndrome that mimics VN. VS should be considered a potential cause of acute vestibular syndrome, and thorough neurological examination with MRI may be helpful for accurate diagnosis.
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Sergi B, Settimi S, Federici G, Galloni C, Cantaffa C, De Corso E, Lucidi D. Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review. J Pers Med 2022; 12:jpm12101616. [PMID: 36294756 PMCID: PMC9605318 DOI: 10.3390/jpm12101616] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or microsurgical resection or wait and scan (WS). The aim of the review was to clarify which patient and tumor parameters may lead to different therapeutic choices, with a view to a personalized VS approach. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between February and March 2022. The authors defined six parameters that seemed to influence decision-making in VS management: 1-incidental VS; 2-tumor size; 3-tumor regrowth after sRT; 4-subtotal resection; 5-patients' age; 6-symptoms. The initial search yielded 3532 articles, and finally, 812 articles were included. Through a qualitative synthesis of the included studies, management strategies were evaluated and discussed. An individualized proposal of procedures is preferable as compared to a single gold-standard approach in VS decision-making. The most significant factors that need to be considered when dealing with a VS diagnosis are age, tumor size and hearing preservation issues.
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Affiliation(s)
- Bruno Sergi
- Department of Head, Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Unit of Otorhinolaryngology-Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Settimi
- Department of Head, Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Unit of Otorhinolaryngology-Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630154439
| | - Gaia Federici
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Costanza Galloni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Carla Cantaffa
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Eugenio De Corso
- Unit of Otorhinolaryngology-Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Zwierzyńska K, Lachowska M, Sokołowski J, Niemczyk K. Cervical and ocular vestibular evoked myogenic potentials in determining nerve division involvement in patients with a tumor located in the internal auditory canal. Auris Nasus Larynx 2020; 48:383-393. [PMID: 32972774 DOI: 10.1016/j.anl.2020.09.006] [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: 07/15/2020] [Revised: 08/20/2020] [Accepted: 09/11/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study aimed at the analysis of the parameters of acoustic cervical and ocular vestibular evoked myogenic potentials (AC-cVEMP and AC-oVEMP) response in patients with a confirmed tumor located in the internal auditory canal. It also aimed to assess to what degree a combination of these tests may be of benefit in the preoperative indication of the affected nerve division via preoperative determination whether the tumor originated from the superior or inferior division of the vestibular nerve, both divisions, or if it originated from a different nerve in the internal auditory canal. METHODS The study group included 50 patients. Preoperative MRI scans were used to measure tumor diameter. AC-cVEMP and AC-oVEMP testing were performed before tumor resection. The surgeon was asked for a detailed description of the tumor origin. RESULTS The corrected amplitude of cVEMP was significantly lower on the tumor side than on the non-affected side and in the control group. The corrected Asymmetry Ratio (AR) of cVEMPs in patients with the tumor was significantly elevated above the reference values with the mean being 58.29% and the mean AR of oVEMPs in patients the tumor was 71.78% which made both results significantly higher than in the control group. Neither cVEMP nor oVEMP latency was significantly correlated with tumor size. Data obtained from cVEMP and oVEMP tests was an effective indicator of tumor origin in 74% of patients showing which division (or both divisions) of the VIIIth nerve was affected in comparison with information obtained from the surgeon. CONCLUSIONS The combined use of AC-cVEMP and AC-oVEMP tests may be useful in surgical planning in patients the tumor located in the internal auditory canal, providing a highly probable determination of the division of the affected nerve. Such information is valuable for the surgeon as it offers additional knowledge about the tumor before the procedure. cVEMP and oVEMP results may not be used as the basis for the calculation of tumor size in patients.
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Affiliation(s)
- Klaudyna Zwierzyńska
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa (Warsaw), Poland
| | - Magdalena Lachowska
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa (Warsaw), Poland.
| | - Jacek Sokołowski
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa (Warsaw), Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa (Warsaw), Poland
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Aalling M, Skals RK, Abrahamsen ER, Hougaard DD. Comparison of test results from two separate video head impulse test systems in a cohort of patients diagnosed with a unilateral vestibular schwannoma. Eur Arch Otorhinolaryngol 2020; 277:3185-3193. [PMID: 32564123 DOI: 10.1007/s00405-020-06116-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/06/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Video head impulse testing (vHIT) is a relatively new technology enabling evaluation of vestibular function. The aim of this study was to compare the test results from two separate vHIT systems in a group of patients diagnosed with a unilateral vestibular schwannoma (VS) with regards to sensitivity, specificity and inter-examiner differences. METHODS Forty-two patients were examined with two separate vHIT systems: EyeSeeCam® (system A) and ICS Impulse® (system B), by one of two examiners. All six semicircular canals (SCCs) were tested under standardized conditions, and strict criteria were set up for post-test interpretation. RESULTS With the majority of test parameters, the two test systems were in agreement. Vestibular deficits were found in 40.5% (system A) to 45% (system B) of patients with a VS on the tested side; corresponding to a positive predictive value (PPV) of 86.4% (system B) to 94.4% (system A). The specificity was 97.6% for system A and 92.9% for system B. An overall agreement between the two vHIT systems measured as kappa was computed to be 0.61. There were no significant inter-examiner differences. When testing the vertical SCCs, a tendency of too high mean gain values was seen with system A but not with system B. CONCLUSION In patients with unilateral VS, vHIT is a test with moderate sensitivity and high specificity in regard to identification of a vestibular deficit. There were no significant differences in test results between the two vHIT systems.
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Affiliation(s)
- Mathilde Aalling
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Regitze Kuhr Skals
- Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark
| | - Emil Riis Abrahamsen
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Dan Dupont Hougaard
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Chae R, McDermott M, Muacevic A, Adler JR, Sharon JD. Vestibular Migraine Following Radiosurgery for Vestibular Schwannoma. Cureus 2020; 12:e8569. [PMID: 32670705 PMCID: PMC7358935 DOI: 10.7759/cureus.8569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Vestibular schwannoma (VS) is associated with dizziness and vertigo during all stages of treatment. This report describes a patient who presented with a one-year history of intermittent motion sickness, dizziness, headache, imbalance, and nausea. MRI showed a right-side VS in the cerebellopontine angle and internal auditory canal. The patient elected to undergo Gamma Knife radiosurgery for treatment. Within two to three months, she continued to experience recurring dizziness, vertigo, neck stiffness, and head pressure. She was referred for neurotology evaluation, which led to a diagnosis of vestibular migraine (VM). Her vestibular reflexes were intact. Subsequently, she was treated with diet modification and low-dose venlafaxine. She reported dramatically improved dizziness and vertigo symptoms at six-month follow-up. VM is a very common cause of dizziness that should always be included in the differential diagnosis, even in VS patients.
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Affiliation(s)
- Ricky Chae
- Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, USA
| | | | | | - John R Adler
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA.,Radiation Oncology, Stanford University Medical Center, Stanford, USA
| | - Jeffrey D Sharon
- Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, USA
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Nilsen KS, Lund-Johansen M, Nordahl SHG, Finnkirk M, Goplen FK. Long-term Effects of Conservative Management of Vestibular Schwannoma on Dizziness, Balance, and Caloric Function. Otolaryngol Head Neck Surg 2019; 161:846-851. [DOI: 10.1177/0194599819860831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ObjectivesTo study the development of dizziness, caloric function, and postural sway during long-term observation of untreated vestibular schwannoma patients.Study DesignRetrospective review of a prospectively maintained longitudinal cohort.SettingTertiary referral hospital.Subjects and MethodsPatients with vestibular schwannoma undergoing wait-and-scan management were included—specifically, those who did not require treatment during a minimum radiologic follow-up of 1 year. Baseline data and follow-up included magnetic resonance imaging, posturography, bithermal caloric tests, and a dizziness questionnaire. Main outcomes were prevalence of moderate to severe dizziness, canal paresis, and postural instability at baseline and follow-up, as compared with McNemar’s test.ResultsOut of 433 consecutive patients with vestibular schwannoma, 114 did not require treatment during follow-up and were included. Median radiologic follow-up was 10.2 years (interquartile range, 4.5 years). Age ranged from 31 to 78 years (mean, 59 years; SD, 10 years; 62% women). Median tumor volume at baseline was 139 mm3(interquartile range, 314 mm3). This did not change during follow-up ( P = .446). Moderate to severe dizziness was present in 27% at baseline and 19% at follow-up ( P = .077). Postural unsteadiness was present in 17% at baseline and 21% at follow-up ( P = .424). Canal paresis was present in 51% at baseline and 56% at follow-up ( P = .664).ConclusionsThere was no significant change in the prevalence of dizziness, postural sway, or canal paresis during conservative management of vestibular schwannoma, while tumor volume remained unchanged. This indicates a favorable prognosis in these patients with regard to vestibular symptoms.
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Affiliation(s)
- Kathrin Skorpa Nilsen
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Otorhinolaryngology–Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Helge Glad Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Monica Finnkirk
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Otorhinolaryngology–Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Goshtasbi K, Abouzari M, Moshtaghi O, Sahyouni R, Sajjadi A, Lin HW, Djalilian HR. The changing landscape of vestibular schwannoma diagnosis and management: A cross-sectional study. Laryngoscope 2019; 130:482-486. [PMID: 30953401 DOI: 10.1002/lary.27950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/05/2019] [Accepted: 03/06/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To assess the current state of the diagnosis and management of vestibular schwannoma (VS) as well as treatment trends, and to evaluate the role of treatment setting and various specialists in treatment plan. METHODS Patients diagnosed with VS completed a voluntary and anonymous survey. The questionnaires were distributed through Acoustic Neuroma Association website, Facebook page, and e-mail newsletters from January to March 2017. RESULTS In total, 789 VS patients completed the survey. Of those, 414 (52%) underwent surgery; 224 (28%) underwent radiotherapy; and 121 (15%) were observed. General otolaryngologists diagnosed 62% of responders, followed by primary care (11%) and neurotologists (10%). Patients who underwent surgery were significantly younger and had larger tumors compared to those treated with radiation or observation. The ratio of patients having nonsurgical versus surgical resection changed from 1:2 to 1:1 for the periods of 1979 through 2006 versus 2007 through 2017, respectively. Neurosurgeons (40%) and neurotologists (38%) were the most influential in treatment discussion. Neurotologists (P < 0.001) and general otolaryngologists (P = 0.04) were more influential than neurosurgeons for the decision process in patients with smaller tumors. Patients treated at academic versus nonacademic private institutions reported similar tumor sizes (P = 0.27), treatment decisions (P = 0.09), and decision satisfaction (P = 0.78). CONCLUSION There is a continuing trend toward nonsurgical management, with approximately half of the patients opting for nonsurgical management. In this cohort, the patients commonly presented with otologic symptoms and otolaryngologists made the most diagnoses. Neurotologists and neurosurgeons were the most influential in treatment discussion. LEVEL OF EVIDENCE NA Laryngoscope, 130:482-486, 2020.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Omid Moshtaghi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Ronald Sahyouni
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, Irvine, California, U.S.A
| | - Autefeh Sajjadi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, Irvine, California, U.S.A
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Zhou Y, Zhao W, Tian L, Yu J, Yuan Y, Wang J. The prediction of the tumor size of a vestibular schwannoma by clinical performance and vestibular function tests. J Neurooncol 2018; 140:679-686. [PMID: 30238349 DOI: 10.1007/s11060-018-2998-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/10/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the relationship between vestibular schwannoma (VS) size and the dysfunction and compensation of the vestibular system. METHODS One hundred fifty-two patients with unilateral VS were investigated using multiple auditory-vestibular function tests such as audiometry, sensory organization test (SOT), caloric test, cervical vestibular-evoked myogenic potential (cVEMP) test, and ocular VEMP (oVEMP) test. RESULTS In this study, 89% of patients with unilateral VS had mild to severe hearing loss on the involved side. All patients showed higher threshold values or no response in the cVEMP and oVEMP tests, which both exhibited a lower response rate on the affected side than on the unaffected side. Patients with a tumor size ≥ 30 mm had significantly lower equilibrium scores for condition 5 and condition 6 of the SOT, which were associated with vestibular dysfunction, higher rates of canal paresis in the caloric test, and lower response rates in the cVEMP and oVEMP tests on the affected sides, compared with the results of patients with a tumor size ≤ 14 mm and patients with a tumor size of 15-29 mm. CONCLUSIONS A diameter > 30 mm may be the critical threshold at which vestibular function is affected and vestibular compensation is interfered with by a VS tumor. Functional performance of the vestibular system can help clinicians predict the size of a tumor and provide a basis for the development of treatment protocols.
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Affiliation(s)
- Yujuan Zhou
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China
| | - Weidong Zhao
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China
| | - Liang Tian
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China
| | - Jing Yu
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China
| | - Yasheng Yuan
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China.
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China.
| | - Jing Wang
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, People's Republic of China.
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China.
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Abstract
OBJECTIVE To report findings from a cohort of vestibular schwannoma (VS) patients presenting with vertigo from a secondary comorbid vestibular disorder; and to discuss management strategies for this subset of patients presenting with both episodic vertigo and VS. PATIENTS All VS patients who presented with vertigo as the primary symptom from 2012 to 2015 and endorsing no other major complaints were examined. INTERVENTION Treatment with migraine lifestyle and prophylactic therapy, or Epley maneuver. MAIN OUTCOME MEASURE Resolution of vertigo following medical treatment alone. RESULTS Of the nine patients studied, seven (78%) suffered from vestibular migraine, and two (22%) experienced benign positional vertigo. All patients experienced complete resolution of symptoms after treatment. As a result of symptomatic improvement, seven patients (78%) avoided surgery in favor of observation, while two patients (22%) underwent radiosurgery due to continued tumor growth and other nonvertigo symptoms. CONCLUSION VS patients can sometimes present with a history of recurrent episodic vertigo. The etiology of the vertigo could be due to the tumor itself or may be due to an underlying comorbidity such as vestibular migraine or benign positional vertigo. VS patients presenting with vertigo should undergo a standard vertigo history and examination to identify other potential causes of vertigo. Most VS patients in our cohort avoided intervention and had resolution of their vertigo.
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Ribeyre L, Spitz E, Frère J, Gauchard G, Parietti-Winkler C. Correlations between postural control and psychological factors in vestibular schwannoma patients. J Vestib Res 2016; 26:387-394. [DOI: 10.3233/ves-160588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Laurence Ribeyre
- University of Lorraine, University of Paris Descartes, Apemac EA 4360, Metz, France
- Department of ENT, University Hospital of Nancy, Nancy, France
| | - Elisabeth Spitz
- University of Lorraine, University of Paris Descartes, Apemac EA 4360, Metz, France
| | - Julien Frère
- University of Lorraine, DevAH EA3450, Vandoeuvre Les Nancy, France
| | - Gerome Gauchard
- University of Lorraine, DevAH EA3450, Vandoeuvre Les Nancy, France
| | - Cécile Parietti-Winkler
- University of Lorraine, DevAH EA3450, Vandoeuvre Les Nancy, France
- Department of ENT, University Hospital of Nancy, Nancy, France
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Abstract
OBJECTIVE Otologic trauma was the most common physical injury sustained after the April 15, 2013, Boston Marathon bombings. The goal of this study is to describe the resultant otologic morbidity and to report on early outcomes. STUDY DESIGN Multi-institutional prospective cohort study. METHODS Children and adults seen for otologic complaints related to the Boston Marathon bombings comprised the study population. Participants completed symptom assessments, quality-of-life questionnaires, and audiograms at initial and 6-month visits. Otologic evaluation and treatment, including tympanoplasty results, were reviewed. RESULTS More than 100 patients from eight medical campuses have been evaluated for blast-related otologic injuries; 94 have enrolled. Only 7% had any otologic symptoms before the blasts. Ninety percent of hospitalized patients sustained tympanic membrane perforation. Proximity to blast (RR = 2.7, p < 0.01) and significant nonotologic injury (RR = 2.7, p < 0.01) were positive predictors of perforation. Spontaneous healing occurred in 38% of patients, and tympanoplasty success was 86%. After oral steroid therapy in eight patients, improvement in hearing at 2 and 4 kHz was seen, although changes did not reach statistical significance. Hearing loss, tinnitus, hyperacusis, and difficulty hearing in noise remain persistent and, in some cases, progressive complaints for patients. Otologic-specific quality of life was impaired in this population. CONCLUSION Blast-related otologic injuries constitute a major source of ongoing morbidity after the Boston Marathon bombings. Continued follow-up and care of this patient population are warranted.
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Quality of Life in Vestibular Schwannoma Patients Managed by Surgical or Conservative Approaches. Otol Neurotol 2015; 36:1245-54. [DOI: 10.1097/mao.0000000000000789] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dayal M, Perez-Andujar A, Chuang C, Parsa AT, Barani IJ. Management of vestibular schwannoma: focus on vertigo. CNS Oncol 2015; 2:99-104. [PMID: 25054360 DOI: 10.2217/cns.12.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This article reviews published literature on vertigo and a 'sense of imbalance' affecting patients who are treated with radiosurgery (RS) for vestibular schwannoma. This is a relatively understudied complaint, along with tinnitus, in this patient population, despite its significant impact on quality of life. It is also a symptom that is most inconsistently impacted by either RS or surgery. This article aims to highlight the importance of this symptom in patients managed for vestibular schwannoma primarily with RS to encourage a more systematic study of vertigo as an outcome measure and to help elucidate its potential etiology.
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Affiliation(s)
- Manisha Dayal
- Department of Radiation Oncology, University of California at San Francisco, 505 Parnassus Avenue, Room L-08 (Box 0226), San Francisco, CA 94143-0226, USA
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Audiovestibular factors influencing quality of life in patients with conservatively managed sporadic vestibular schwannoma. Otol Neurotol 2010; 31:968-76. [PMID: 20684063 DOI: 10.1097/mao.0b013e3181e8c7cb] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To measure the health-related quality of life (QoL) of patients undergoing conservative management of a vestibular schwannoma and to identify audiovestibular factors that influence health-related QoL. STUDY DESIGN Cross-sectional case-control study. INTERVENTION Adult patients undergoing conservative management of a sporadic vestibular schwannoma were identified from a prospectively updated database. Each patient was asked to complete a series of questionnaires, including the Short Form 36 health-related QoL instrument, the Hearing Handicap Inventory, the Tinnitus Handicap Inventory, and the Dizziness Handicap Inventory. The QoL data obtained were compared with UK normal data. Multiple linear regression was performed to identify audiovestibular factors influencing QoL. PATIENTS Of 241 patients still undergoing conservative management, 165 completed the questionnaires. The mean age was 66.6 years. Mean duration of follow-up was 5.7 years. RESULTS Physical component summary scores were significantly lower than those of the normal population. Mental component summary scores were significantly above the normal population. Regression analysis showed that dizziness handicap score and age were strong predictors of physical component summary (both p < 0.0001). Dizziness handicap score and tinnitus handicap score were significant predictors of mental component summary (p = 0.0004 and p = 0.027 respectively). However, the model only explained a small amount of the data, suggesting that there may be other factors influencing QoL. CONCLUSION Dizziness is the most significant audiovestibular predictor of QoL in patients with vestibular schwannomas. Tinnitus also has an impact on mental QoL. Hearing loss does not seem to influence QoL. Other factors such as illness perception may have an important role to play in determining QoL.
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