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J Neurol Surg B Skull Base 2013; 74(03): 166-175
DOI: 10.1055/s-0033-1342921
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Patterns of Hearing Loss Following Retrosigmoid Excision of Unilateral Vestibular Schwannoma

Melissa J. Babbage
1   Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
,
Melanie B. Feldman
1   Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
,
Greg A. O'Beirne
1   Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
,
Martin R. MacFarlane
2   Department of Neurosurgery, University of Otago, Christchurch, New Zealand
,
Philip A. Bird
1   Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
3   Department of Otolaryngology – Head and Neck Surgery, Christchurch Public Hospital, Christchurch, New Zealand
› Author Affiliations
Further Information

Publication History

22 August 2012

22 January 2013

Publication Date:
01 April 2013 (online)

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Abstract

Objectives To determine the pattern of auditory responses, time-course of hearing deterioration, and possible site of lesion following retrosigmoid excision of unilateral vestibular schwannomas.

Design Prospective, nonrandomized, observational pilot study.

Setting Tertiary referral medical center.

Main outcome measures Preoperative and postoperative pure-tone and speech audiometry, auditory brainstem response testing, and distortion product otoacoustic emissions were performed in 20 patients. Testing was conducted every 24 hours for the duration of hospitalization. Transtympanic electrocochleography was performed if delayed deterioration of auditory responses was documented.

Results Of the 20 patients, 7 had no discernible cochlear nerve at the end of the procedure. Of the 13 patients with an intact nerve, 6 retained hearing, 3 with evidence of reduced neural function. Of the 7 who lost hearing despite an intact nerve, 5 lost at least cochlear and possibly also neural function, and 1 had reduced neural function but retained cochlear function. There were two examples of delayed deterioration of cochlear nerve responses.

Conclusions Hearing loss following retrosigmoid removal of vestibular schwannomas most often involves loss of at least cochlear function, possibly in addition to neural damage. In a smaller number of cases anacusis or hearing deterioration can be attributed to purely neural trauma.

Keywords

acoustic neuroma - vestibular schwannoma - hearing preservation
 

  • References

  • 1 Colletti V, Fiorino FG, Carner M, Tonoli G. Mechanisms of auditory impairment during acoustic neuroma surgery. Otolaryngol Head Neck Surg 1997; 117 (6) 596-605
    CrossrefPubMedGoogle Scholar
  • 2 Kim AH, Edwards BM, Telian SA, Kileny PR, Arts HA. Transient evoked otoacoustic emissions pattern as a prognostic indicator for hearing preservation in acoustic neuroma surgery. Otol Neurotol 2006; 27 (3) 372-379
    Google Scholar
  • 3 Morlet T, Dubreuil C, Duclaux R, Ferber-Viart C. Preoperative speech and pure-tone audiometry in four types of patients with acoustic neuroma. Am J Otolaryngol 2003; 24 (5) 297-305
    CrossrefPubMedGoogle Scholar
  • 4 Levine RA, Ojemann RG, Montgomery WW, McGaffigan PM. Monitoring auditory evoked potentials during acoustic neuroma surgery. Insights into the mechanism of the hearing loss. Ann Otol Rhinol Laryngol 1984; 93 (2 Pt 1) 116-123
    PubMedGoogle Scholar
  • 5 Sekiya T, Iwabuchi T, Kamata S, Ishida T. Deterioration of auditory evoked potentials during cerebellopontine angle manipulations. An interpretation based on an experimental model in dogs. J Neurosurg 1985; 63 (4) 598-607
    CrossrefPubMedGoogle Scholar
  • 6 Sekiya T, Møller AR. Cochlear nerve injuries caused by cerebellopontine angle manipulations. An electrophysiological and morphological study in dogs. J Neurosurg 1987; 67 (2) 244-249
    CrossrefPubMedGoogle Scholar
  • 7 Friedman RA, Brackmann DE, Mills D. Auditory-nerve integrity after middle-fossa acoustic-tumor removal. Otolaryngol Head Neck Surg 1998; 119 (6) 588-592
    Google Scholar
  • 8 Perlman HB, Kimura R, Fernandez C. Experiments on temporary obstruction of the internal auditory artery. Laryngoscope 1959; 69 (6) 591-613
    PubMedGoogle Scholar
  • 9 Committee on Hearing and Equilibrium. American Academy of Otolaryngology – Head and Neck Surgery. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). Otolaryngol Head Neck Surg 1995; 113 (3) 179-180
    CrossrefPubMedGoogle Scholar
  • 10 Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 1988; 97 (1) 55-66
    CrossrefPubMedGoogle Scholar
  • 11 Brackmann DE, Owens RM, Friedman RA , et al. Prognostic factors for hearing preservation in vestibular schwannoma surgery. Am J Otol 2000; 21 (3) 417-424
    CrossrefPubMedGoogle Scholar
  • 12 Dornhoffer JL, Helms J, Hoehmann DH. Hearing preservation in acoustic tumor surgery: results and prognostic factors. Laryngoscope 1995; 105 (2) 184-187
    CrossrefPubMedGoogle Scholar
  • 13 Robinette MS, Bauch CD, Olsen WO, Harner SG, Beatty CW. Nonsurgical factors predictive of postoperative hearing for patients with vestibular schwannoma. Am J Otol 1997; 18 (6) 738-745
    Google Scholar
  • 14 Josey AF, Glasscock III ME, Jackson CG. Preservation of hearing in acoustic tumor surgery: audiologic indicators. Ann Otol Rhinol Laryngol 1988; 97 (6 Pt 1) 626-630
    Google Scholar
  • 15 Shimamura N, Sekiya T, Yagihashi A, Suzuki S. Temporal pattern of cochlear nerve degeneration following compression injury: a quantitative experimental observation. J Neurosurg 2002; 97 (4) 929-934
    CrossrefPubMedGoogle Scholar
  • 16 Cacace AT, Parnes SM, Lovely TJ, Kalathia A. The disconnected ear: phenomenological effects of a large acoustic tumor. Ear Hear 1994; 15 (4) 287-298
    CrossrefPubMedGoogle Scholar
  • 17 Hatayama T, Sekiya T, Suzuki S, Iwabuchi T. Effect of compression on the cochlear nerve: a short- and long-term electrophysiological and histological study. Neurol Res 1999; 21 (6) 599-610
    PubMedGoogle Scholar
  • 18 Sekiya T, Møller AR, Jannetta PJ. Pathophysiological mechanisms of intraoperative and postoperative hearing deficits in cerebellopontine angle surgery: an experimental study. Acta Neurochir (Wien) 1986; 81 (3-4) 142-151
    CrossrefPubMedGoogle Scholar
  • 19 Sekiya T, Yagihashi A, Asano K, Suzuki S. Nimodipine ameliorates trauma-induced cochlear neuronal death. Neurol Res 2002; 24 (8) 775-780
    CrossrefPubMedGoogle Scholar
  • 20 Strauss C, Bischoff B, Neu M, Berg M, Fahlbusch R, Romstöck J. Vasoactive treatment for hearing preservation in acoustic neuroma surgery. J Neurosurg 2001; 95 (5) 771-777
    CrossrefPubMedGoogle Scholar
  • 21 Colletti V, Fiorino FG, Mocella S, Policante Z. ECochG, CNAP and ABR monitoring during vestibular Schwannoma surgery. Audiology 1998; 37 (1) 27-37
    CrossrefPubMedGoogle Scholar
  • 22 Sabin HI, Prasher DK, Bentivoglio P, Symon L. Preservation of cochlear potentials in a deaf patient fifteen months after excision of an acoustic neuroma. Scand Audiol 1987; 16 (2) 109-111
    CrossrefPubMedGoogle Scholar
  • 23 Galambos R. The BER in the ICU. In: Naunton RF, Fernandex C, , eds. Evoked Electrical Activity in the Auditory System. New York: Academic Press; 1978: 405-408
    Google Scholar
  • 24 Hashimoto I, Ishiyama Y, Yoshimoto T, Nemoto S. Brain-stem auditory-evoked potentials recorded directly from human brain-stem and thalamus. Brain 1981; 104 (Pt 4) 841-859
    CrossrefPubMedGoogle Scholar