Risk stratification for immediate postoperative hearing loss by preoperative BAER (brainstem auditory evoked response) and audiometry in NF2-associated vestibular schwannomas

Please always quote using this URN: urn:nbn:de:bvb:20-opus-234165
  • Both brainstem auditory evoked potentials (BAEP) and audiometry play a crucial role in neuro-oncological treatment decisions in Neurofibromatosis Type 2 associated (NF2) vestibular schwannoma (VS) as hearing preservation is the major goal. In this study, we investigated the risk of immediate postoperative hearing deterioration (>15 dB and/or 15% loss in pure-tone average [PTA]/ speech discrimination score [SDS] in a cohort of 100 operated VS (ears) in 72 NF2 patients by retrospective analysis of pre- and postoperative hearing data (PTA, SDS,Both brainstem auditory evoked potentials (BAEP) and audiometry play a crucial role in neuro-oncological treatment decisions in Neurofibromatosis Type 2 associated (NF2) vestibular schwannoma (VS) as hearing preservation is the major goal. In this study, we investigated the risk of immediate postoperative hearing deterioration (>15 dB and/or 15% loss in pure-tone average [PTA]/ speech discrimination score [SDS] in a cohort of 100 operated VS (ears) in 72 NF2 patients by retrospective analysis of pre- and postoperative hearing data (PTA, SDS, American Association of Otolaryngology–Head and Neck Surgery [AAO-HNS], and brainstem auditory evoked potential [BAEP] class) taking into account relevant influencing factors, particularly preoperative audiometry and BAEP status and the extent of resection. Immediately after surgery, the hearing was preserved in 73% of ears and approximately ~60% of ears kept their hearing classes. Preoperative BAEP (p = 0.015) and resection amount (p = 0.048) significantly influenced postoperative hearing outcome. The prediction model for postoperative hearing deterioration/loss between preoperative BAEP and AAO-HNS class showed increased risk by increasing BAEP class. Twenty-one tumors/ears were identified with large BAEP and AAO-HNS class discrepancies (≥2 points) and were associated with a high (48–100%) risk of deafness after surgery in ears with preoperative available hearing. Overall, the results were heterogeneous but the better both BAEP and audiometry class before surgery, the higher the chance of hearing maintenance afterwards. Large resection amounts (e.g., 100% risk in near-total resections) exhibit a significant (p < 0.05) higher risk compared to smaller amounts (e.g., 10/20% in laser-coagulated/partially resected tumors). Our results emphasized the indispensable role of both hearing monitoring in form of audiometry and neurophysiology (BAEP) in the pre-and perioperative monitoring of NF2-associated VS. Both BAEP and audiometry are good prognostic markers for the postoperative hearing outcome. The extent of resection should be strictly guided by and adjusted to the intraoperative neurophysiological monitoring.show moreshow less

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Metadaten
Author: Isabel Gugel, Florian Grimm, Philip Hartjen, Maria Breun, Julian Zipfel, Marina Liebsch, Hubert Löwenheim, Ulrike Ernemann, Lan Kluwe, Victor-Felix Mautner, Marcos Tatagiba, Martin Ulrich Schuhmann
URN:urn:nbn:de:bvb:20-opus-234165
Document Type:Journal article
Faculties:Medizinische Fakultät / Neurochirurgische Klinik und Poliklinik
Language:English
Parent Title (English):Cancers
ISSN:2072-6694
Year of Completion:2021
Volume:13
Issue:6
Article Number:1384
Source:Cancers (2021) 13:6, 1384. https://doi.org/10.3390/cancers13061384
DOI:https://doi.org/10.3390/cancers13061384
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Tag:audiometry; brainstem auditory evoked potentials; hearing preservation; neurofibromatosis type 2; vestibular schwannoma
Release Date:2022/07/25
Date of first Publication:2021/03/18
Licence (German):License LogoCC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International