Preoperative Sudden Hearing Loss May Predict Hearing Preservation After Retrosigmoid Resection of Vestibular Schwannoma

Establishment of Nomogram for Prediction of Hearing Preservation after Retrosigmoid Approach in Patients with Vestibular Schwannoma

OBJECTIVE

To derive and validate a prognostic nomogram for the prediction of hearing preservation (HP) after retrosigmoid approach (RSA) in patients with vestibular schwannoma (VS) and further assist in clinical decision-making.

STUDY DESIGN

Retrospective study.

SETTING

Tertiary referral center.

PATIENTS

A total of 111 patients diagnosed with VS with serviceable hearing from January 2013 to March 2023.

INTERVENTIONS

All patients underwent surgery via RSA, and hearing outcomes were reviewed 2 weeks postoperatively.

MAIN OUTCOME MEASURES

Preoperative and postoperative hearing were analyzed and stratified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS).

RESULTS

In multivariate analysis of the primary group, preoperative hearing, tumor size, and tumor origin were significantly related to postoperative HP ( p = 0.029, p = 0.043, and p = 0.018, respectively). Factors derived from the multivariate analysis were all assembled into the nomogram. The receiver operating characteristic (ROC) curves showed good predictive accuracy of the nomogram model in both primary and validation groups with area under the ROC curve (AUC) values of 0.802 and 0.797, respectively.

CONCLUSION

Independent predictors of postoperative HP in patients with VS were selected to create the nomogram. The nomogram was able to stratify patients into different risk groups and assist in clinical decision making.

Efficacy of Mesotympanum Injection and Posterior Auricular Injection in Sudden Hearing Loss of Diabetes Patients

The efficacy of tympanum injection and posterior auricular injection in diabetes with sudden hearing loss (SHL) was analyzed. A mobile terminal-based portable pure tone audiometry system and its processing method were established. Based on mobile terminals, a portable pure tone audiometry system including an Android system, pure sound signal generation, pure tone hearing threshold, and client module was established. A masking model and self-adaptive algorithm were used to detect and reduce noise. Besides, the performance of the portable pure tone audiometry system was detected. A total of 46 diabetes patients with SHL diagnosed at the otolaryngology department in BeiChen Hospital between August 2019 and November 2021 were selected as the research objects and randomly divided into the retroauricular group (posterior auricular injection) and the tympanic group (tympanum injection). Each group included 23 cases. All patients received pure tone audiometry (PTA) before and after the treatment. The changes in fasting blood glucose (FPG), 2h postprandial blood glucose (2hPG), and glycosylated hemoglobin (HbA1c) of the patients were monitored before and after the treatment. Besides, tinnitus loudness visual analog scale (VAS), pain VAS, efficacy, and the incidence of adverse reactions of the patients in two groups were compared. The results indicated that the hear threshold error detected by the medical audiometer and a portable pure tone audiometry system was within 2dB. Before the optimization, there was an error of about 10dB between the hear thresholds detected by the self-adaptive algorithm and a medical audiometer. After the treatment, the hear threshold and average PTA of the patients in the retroauricular and the tympanic groups under different frequencies were both reduced compared with those before the treatment (P < 0.05). The tinnitus VAS score in the retroauricular group was decreased more notably than that in tympanic group (P < 0.01), and the pain VAS score was much lower than that in the tympanic group (P < 0.001). The comparison of FPG, 2hPG, HbA1c, the proportions of cured, significantly effective, effective, ineffective patients, and the total effective rate in the patients in the retroauricular and the tympanic groups before and after the treatment all showed no statistical differences (P > 0.05). The incidence of adverse reactions in tympanic group after the treatment was dramatically higher than that in retroauricular group (P < 0.001). The above results demonstrated that posterior auricular injection showed potential application values in the treatment of SHL with diabetes and established a portable pure tone audiometry system as well as its noise processing method.

Clinical Staging to Estimate the Probability of Severe Postoperative Complications in Patients With Vestibular Schwannoma

Importance

Vestibular schwannomas have long been treated as a homogeneous entity. Clinical symptoms at presentation may help elucidate the underlaying pathophysiologic characteristics of tumor subtypes. Describing the heterogeneity of these benign tumors may assist in predicting clinical outcomes associated with their treatment.

Objective

To create a tumor staging system that incorporates symptoms at presentation and tumor size to predict severe surgical complications.

Design, Setting, and Participants

A retrospective cohort of patients at a single-center tertiary referral center from January 1, 1998, to October 13, 2020, was studied. Patients diagnosed with sporadic vestibular schwannoma surgically treated at Washington University in St Louis, Missouri, were included.

Main Outcomes and Measures

Severe surgical complications within 30 days of surgery as determined by the Clavien-Dindo classification system. Patients experiencing a complication of grade 3 or above were determined to have a severe complication.

Results

Of 185 patients evaluated, 40 (22%) had severe postoperative complications. Twenty of the 40 patients (50%) were women; mean (SD) age was 46 (13) years. Patients with severe complications were more likely to have large tumors (>2.5 cm in largest diameter), vestibular symptoms, and recent hearing loss at presentation. Using conjunctive consolidation, a 4-stage clinical severity staging system that incorporates clinical symptoms and tumor size at presentation was created to predict severe complications. The clinical severity staging system demonstrated an improvement in the ability to discriminate severe complications (C index, 0.754; 95% CI, 0.67-0.84) from a model of tumor size alone (C index, 0.706; 95% CI 0.62-0.79).

Conclusions and Relevance

This cohort study found that, among patients with vestibular schwannoma, symptoms present at initial evaluation, in addition to tumor size, served as predictors of severe postoperative complications. A new clinical severity staging system incorporating symptoms at presentation can be helpful for clinicians to identify patients at high risk for severe postoperative complications.