Brain-stem auditory evoked responses in 56 patients with acoustic neurinoma

Rapid Increase in Neural Conduction Time in the Adult Human Auditory Brainstem Following Sudden Unilateral Deafness

Individuals with sudden unilateral deafness offer a unique opportunity to study plasticity of the binaural auditory system in adult humans. Stimulation of the intact ear results in increased activity in the auditory cortex. However, there are no reports of changes at sub-cortical levels in humans. Therefore, the aim of the present study was to investigate changes in sub-cortical activity immediately before and after the onset of surgically induced unilateral deafness in adult humans. Click-evoked auditory brainstem responses (ABRs) to stimulation of the healthy ear were recorded from ten adults during the course of translabyrinthine surgery for the removal of a unilateral acoustic neuroma. This surgical technique always results in abrupt deafferentation of the affected ear. The results revealed a rapid (within minutes) reduction in latency of wave V (mean pre = 6.55 ms; mean post = 6.15 ms; p < 0.001). A latency reduction was also observed for wave III (mean pre = 4.40 ms; mean post = 4.13 ms; p < 0.001). These reductions in response latency are consistent with functional changes including disinhibition or/and more rapid intra-cellular signalling affecting binaurally sensitive neurons in the central auditory system. The results are highly relevant for improved understanding of putative physiological mechanisms underlying perceptual disorders such as tinnitus and hyperacusis.

ABR in the diagnosis of vestibular schwannomas: a meta-analysis

PURPOSE

The aim of this study is to rigorously evaluate the role of auditory brainstem response (ABR) testing in the diagnosis of vestibular schwannomas (VS).

MATERIALS AND METHODS

Searches were conducted in multiple online databases, supplemented by hand searches. From the studies chosen for final inclusion, relevant data were extracted and meta-analysis of pooled data was performed.

RESULTS

623 studies were identified from which 43 met inclusion criteria for analysis (1978 to 2009) including 3314 patients. Pooled sensitivity for ABR detection of vestibular schwannomas was 93.4% (95% CI 92.6-94.3, P=0.0000). For tumors less than 1cm (8 studies, 176 patients) sensitivity was 85.8% (95% CI 80.6-90.1, P=0.0116). For tumors greater than 1cm (6 studies, 251 patients) pooled sensitivity was 95.6% (95% CI 93.1-98.2, P=0.0660). Sensitivity of ABR to detect extracanalicular tumors was higher than for intracanalicular tumors, though pooled data were not statistically valid. Pooled specificity (8 studies, 2432 patients) was 82.0% (95% CI 80.5-83.6, P=0.0000).

CONCLUSIONS

Although MRI remains the gold standard, emerging trends towards more conservative management coupled with limited financial resources may prompt many clinicians to review the role of ABR testing in screening for retrocochlear pathology. In light of the high sensitivity and specificity of ABR testing for VS, we strongly urge its reconsideration as a useful diagnostic tool for patients with clinically suspected VS.

Evolution of vestibular schwannoma surgery: the long journey to current success

The extraordinary improvement of patient outcome after surgical treatment for vestibular schwannomas is relatively recent and has occurred mainly over the last 30 years. The introduction of microsurgical techniques has resulted in increasing degrees of precise anatomical and functional preservation of the facial and cochlear nerves. An expanded microsurgical technique accompanied by continuous electrophysiological monitoring has resulted in marked changes in the primary goals for this surgery. Whereas in the past the primary goal of vestibular schwannoma management was to preserve the patient's life, the objective in vestibular schwannoma treatment today is to preserve neurological function.

Long-term follow-up examinations show negligible recurrence rates, indicating that the aim of preservation of nerve function does not limit the completeness of tumor removal with modern neurosurgical techniques. Despite these advances in preserving the anatomical integrity of, for example, the cochlear nerve, losses of function and even deafness may occur postoperatively in some cases. Current biological and technical research in experimental and clinical settings addresses these problems. In this article, the authors report in detail the developments achieved in vestibular schwannoma surgery and the great clinicians to whom these results can be credited.

Stacked tone-burst-evoked auditory brainstem response (ABR): preliminary findings

In 1997, Don and his co-workers described a new method for evaluating the auditory brainstem response (ABR)--yielding the stacked-wave-V ABR--which may permit the reliable detection of even small vestibular schwannomas (VSs). However, this method requires a masking technique that may not be readily available to the clinician. Furthermore, relatively high-level noise is required and may be annoying to the patient. An alternative method that might permit the same manipulation of the ABR was thus explored whereby tone-bursts (TBs) were used to obtain frequency-specific ABRs. The goal of the study was to determine whether TBs could be used to achieve the sort of de-convolution and subsequent enhancement of wave V reported with the original method of Don et al. First, the TB-stacked ABR (wave V) was compared to that obtained using derived narrowband masked ABRs in young normal-hearing subjects. Second, the TB method was employed in subjects with unilateral VSs and in patients with unilateral sensory hearing loss in a preliminary clinical trial. The observed results are promising for the use of the TB method as an alternative approach to ABR 'stacking' and warrant further research and development of the TB method.

Brainstem response in cerebellopontine angle tumors

OBJECTIVE

To evaluate the auditory brainstem response (ABR) findings in cerebellopontine angle (CPA) tumors and focus on those with normal ABR results.

STUDY DESIGN

This was a retrospective evaluation of ABR findings. All subjects with diagnosed CPA tumors who were referred for treatment were included.

PATIENTS

All 309 patients with radiographically confirmed (computed tomography or magnetic resonance imaging [MRI]) CPA tumors (153 before 1993 and 156 after 1993).

INTERVENTION

All patients underwent complete audiologic examination, electronystagmography, ABR testing, and ipsilateral transtympanic electrocochleography. All tumors were histologically confirmed.

MAIN OUTCOME MEASURES

The patients were categorized according to ABR results (normal or pathologic findings or no response); according to histology (vestibular schwannomas or meningiomas); and according to tumor size by MRI (small, up to 15 mm; medium, 16-25 mm; large, 26-40 mm; and very large, over 40 mm).

RESULTS

Normal ABR results were found in 18.4%; pathologic ABR results in 31.4%; and no response in 50.2%. Small vestibular schwannomas (under 15 mm) showed a higher incidence of normal ABR results (41.7%). CPA tumors with normal ABR results (n = 57) caused no hearing loss (n = 12), symmetrical hearing loss (n = 11), or ipsilateral hearing loss with Short Increment Sensitivity Index 100% and normal acoustic reflex (cochlear deafness, n = 34). Caloric response was normal in 59.7% of these tumors.

CONCLUSION

Because validation of ABR as screening for acoustic tumors is based on diagnosed tumors, and because MRI allows detection of very small tumors, the incidence of normal ABR increases and its sensitivity would be expected to decrease. ABR is not sufficient for early detection of small CPA tumors.

Management of vestibular schwannomas (acoustic neuromas): the value of neurophysiology for evaluation and prediction of auditory function in 420 cases

OBJECTIVE

From 1978 to 1993, 1000 vestibular schwannomas were operated on at the Department of Neurosurgery at Nordstadt Hospital. The goal was to improve the chances of hearing preservation by recording auditory brain stem responses (ABRs). ABRs can be used for preoperative classification of cochlear nerve impairment and for prediction of the chances of hearing preservation.

PATIENTS AND METHODS

In addition to the previously described audiometric testing, the patients underwent perioperative and intraoperative bilateral ABR recording at 100-dB condensation and rarefaction click stimulation. The classification system of five types of ABRs, as presented before, is based on the presence and on the latencies of Waves I, III, and V, with a special emphasis on Wave III's representing the activity of the first brain stem nuclei within the auditory pathway. According to an analysis of 420 preoperative ABRs, in case of a preoperative Type 1 or 2, the rate of hearing preservation is 80%.

DISCUSSION

In the case of good clinical and audiometric hearing, a severely deteriorated ABR is mostly an indicator of severe nerve compression and adhesion by the tumor. In view of subsequently reported experiences with intraoperative ABR monitoring, the value of the presented system emphasizing the importance of Wave III is stressed and discussed with other views in the literature. The criteria presented here are not designed for recognition of retrocochlear disease but aim for evaluation of the state of the auditory nerve and its perspective.

CONCLUSION

By the presented classification of ABR Type B1 through B5, preoperative prediction of the likelihood of hearing preservation is improved.

Full recovery from deafness after removal of a large acoustic neurinoma associated with neurofibromatosis 2: case report

The first case of full recovery from deafness after radical intracapsular removal of a large acoustic neurinoma, more than 4 cm in diameter, is reported. The patient, a 17-year-old woman, had multiple intracranial and intraspinal tumors in addition to bilateral acoustic neurinomas. Radical intracapsular removal is a useful technique to preserve nerves in patients with large acoustic neurinoma. When identifiable evoked potentials are preserved in brain stem auditory evoked potential, hearing preservation should be tried despite preoperative hearing level.

Short latency auditory evoked potentials recorded from non-anaesthetized thoroughbred horses

The Brainstem Auditory Evoked Potential (BAEP) is a recording of the electrical activity of the brainstem following an acoustic stimulation. Up to seven peaks may be identified within 10 ms, and are labelled I to VII. The first five of these peaks are of most clinical importance, and in normal horses, peaks I, III and V are always present at stimulus intensities of 70-100 dB. Repeated sampling of clinically normal subjects at different stimulus intensities has enabled mean latency values to be determined for the ipsilateral and contralateral peaks I, III and V, and also for the interpeak latencies (IPLs) at each intensity. The maximum, normal, absolute latency for ipsilateral peak I was 1.86 ms, for peak III, 3.53 ms and for peak V, 5.52 ms. The equivalent contralateral values were 2.50 ms, 4.44 ms and 5.59 ms. The maximum, normal, contralateral IPL for I-III was 1.78 ms, that for III-V was 2.26 ms and for I-V was 3.76 ms. The maximum, normal, contralateral IPLs were 2.17 ms for I-III, 1.41 ms for III-V and 3.32 ms for I-V. If a peak or peaks are absent or delayed, or the IPL is greater than expected, the patient can be determined to have abnormal brainstem or auditory nerve conduction. The amplitudes of peaks I and V were measured, and the ratio of amplitudes was determined, to find the normal V:I values. At a stimulus intensity of 100 dB, the ipsilateral ratio was 0.49 +/- 0.19, and the contralateral value 1.49 +/- 0.48. Dispersal values were also calculated, by dividing the height of the III-V complex by its duration. For a stimulus intensity of 100 dB, the ipsilateral dispersal value was 0.416 +/- 0.104 microV/ms, and the contralateral value of 0.473 +/- 0.074 microV/ms. A range of normal values for both V:I ratio and dispersal were calculated. Height, weight and inter-aural distance were measured, and the relationship of the various peaks and IPLs to these variables was ascertained by statistical analysis. For the ipsilateral values, the correlation between the latency of wave V, and III-V and I-V IPLs and weight were significant (P less than 0.01). Significant correlations were found between weight and the latency of contralateral waves III (P less than 0.05) and V (P less than 0.05) and the I-III (P less than 0.01) and I-V (P less than 0.001) IPLs.(ABSTRACT TRUNCATED AT 400 WORDS)