Objective: Compare hearing outcome for vestibular schwannoma patients following stereotactic radiosurgery (SRS) or conservative management. Study Design: Retrospective review. Setting: University Hospital. Patients: Patients with small-or medium-sized sporadic vestibular schwannoma (intracanalicular or with CPA component <2 cm) who were managed conservatively or underwent SRS with available clinical, radiological, and audiometric data from the time of presentation (or just before radiotherapy for the SRS group) and most recent follow-up; with the two sets of data to be compared being at least 3 years apart (minimum follow-up period). Interventions: SRS or observation. Main Outcome Measure: Pure-tone averages, speech discrimination scores, and corresponding hearing classifications. Results: Two hundred forty-seven patients met our inclusion criteria; 140 were managed conservatively with a mean follow-up period of 5.9 AE 1.6 years and 107 underwent SRS with a mean follow-up period of 7.1 AE 1.9 years. There was significant deterioration of hearing measures for both groups; with the SRS group displaying consistently worse measures. SRS patients showed worse mean pure-tone averages and speech discrimination scores decline rates by 2.72 dB/yr and 2.98 %/yr, respectively, when compared with conservatively managed patients. Stratifying patients according to Tokyo's hearing classification revealed that 68.75% of conservatively managed patients who had baseline serviceable hearing preserved their hearing throughout the studied period compared with only 15.38% of the SRS patients. Conclusion: Based on our data we conclude that patients with small-and medium-sized tumors will have a better hearing outcome if managed via an initial conservative approach with radiotherapy reserved for those demonstrating disease progression.
Background DPOAEs are acoustic energy within the external auditory canal (EAC) arising from the non-linear interaction within the cochlea; of 2 pure tones presented simultaneously; of primary frequencies f1 and f2. DPOAEs are recorded in nearly any normal-hearing subject and in patients with hearing loss up to 50 dBHL while recordings may be deceiving in the presence of severe to profound hearing loss. Objective To determine the intensity levels of f1 and f2 at which DPOAEs truly reflect the active metabolic processes within the cochlea. Setting University Hospital Study Prospective Methods One-hundred and forty ears were categorized into three groups; A (n = 50), B (n = 50) and C (n = 40); according to subjects' age (12 to 18, 2 to 12 and <2 years, respectively). A fourth group D was included; which entailed recordings from a dummy cavity simulating a child’s external auditory canal. Each group was further subdivided into two subgroups according to hearing levels; either normal or severe to profound hearing loss. DP-grams were interpreted at 3 points/octave steps for all groups and reviewed as ‘Pass’ or ‘Fail’ according to set criteria. Stimulus levels were adjusted such that L1 exceeded L2 by 10 dB. Start levels for L1 and L2 were 80 and 70 dBSPL. Levels were reduced simultanueously in 5 dB steps for the following recordings; to reach 65 and 55 for the last recording. Results Using the higher three stimulation levels, all subgroups had ‘Pass’ DP grams. On using the last and lowest recording level, only subgroups of normal hearing ears had ‘Pass’ DP grams; while subgroups of ears with sensorineural hearing loss (SNHL) demonstrated ‘Failed’ DP grams at all frequencies. Conclusions For audiometric screening purposes, DPOAEs show to be rather insensitive to hearing loss at higher stimulation levels and may reveal false positive results.
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