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Hearing and Vestibular Function After Preoperative Intratympanic Gentamicin Therapy for Vestibular Schwanomma as Part of Vestibular Prehab

Tjernström, Fredrik LU ; Fransson, Per Anders LU ; Kahlon, Babar LU ; Karlberg, Mikael LU ; Lindberg, Sven LU ; Siesjö, Peter LU and Magnusson, Måns LU (2016) In Ear and Hearing 37(6). p.744-750
Abstract

OBJECTIVE:: To evaluate auditory and vestibular function after presurgical treatment with gentamicin in schwannoma patients. BACKGROUND:: The vestibular PREHAB protocol aims at diminishing the remaining vestibular function before vestibular schwannoma surgery, to ensure less acute symptoms from surgery, and initiate a more efficient vestibular rehabilitation already before surgery. However, the potential cochleotoxicity of gentamicin is a concern, since modern schwannoma surgery strives to preserve hearing. STUDY DESIGN:: Retrospective study. SETTING:: University hospital. PATIENTS:: Seventeen patients diagnosed with vestibular schwannoma between 2004 and 2011, and took part in vestibular PREHAB program. The patients were of age 21 to... (More)

OBJECTIVE:: To evaluate auditory and vestibular function after presurgical treatment with gentamicin in schwannoma patients. BACKGROUND:: The vestibular PREHAB protocol aims at diminishing the remaining vestibular function before vestibular schwannoma surgery, to ensure less acute symptoms from surgery, and initiate a more efficient vestibular rehabilitation already before surgery. However, the potential cochleotoxicity of gentamicin is a concern, since modern schwannoma surgery strives to preserve hearing. STUDY DESIGN:: Retrospective study. SETTING:: University hospital. PATIENTS:: Seventeen patients diagnosed with vestibular schwannoma between 2004 and 2011, and took part in vestibular PREHAB program. The patients were of age 21 to 66 years (mean 48.8), 9 females and 8 males. INTERVENTION:: Intratympanic gentamicin installations before surgery as part of the vestibular PREHAB. MAIN OUTCOME MEASURES:: Hearing thresholds, word recognition score, caloric response, subjective visual vertical and horizontal, cVEMP, and vestibular impulse tests. RESULTS:: Combined analysis of frequency and hearing threshold showed a significant decrease after gentamicin therapy (p <0.001). Pure-tone average decreased with 7.1 ± 8.5 dB (p = 0.004), and speech recognition with 10%. The treatment resulted in unilateral vestibular deafferentation with no notable reaction to bithermal caloric irrigation (reduction 64%, p <0.001), loss of the vestibulo-ocular response measured by the head-impulse test, and deviation of subjective horizontal/vertical to the side of the lesion (+2.2 degrees, p = 0.010). CONCLUSIONS:: Intratympanic installations of gentamicin, as part of the vestibular PREHAB, result in unilateral vestibular deafferentation, but constitute a definite risk for high-frequency hearing loss. The hearing results are in line with those reported upon when treating Menière’s disease.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Ear and Hearing
volume
37
issue
6
pages
744 - 750
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:84978982790
ISSN
0196-0202
DOI
10.1097/AUD.0000000000000340
language
English
LU publication?
yes
id
81dfbc44-dec9-47e8-b6af-7526b35e37e6
date added to LUP
2016-08-15 15:58:13
date last changed
2017-01-01 08:31:41
@article{81dfbc44-dec9-47e8-b6af-7526b35e37e6,
  abstract     = {<p>OBJECTIVE:: To evaluate auditory and vestibular function after presurgical treatment with gentamicin in schwannoma patients. BACKGROUND:: The vestibular PREHAB protocol aims at diminishing the remaining vestibular function before vestibular schwannoma surgery, to ensure less acute symptoms from surgery, and initiate a more efficient vestibular rehabilitation already before surgery. However, the potential cochleotoxicity of gentamicin is a concern, since modern schwannoma surgery strives to preserve hearing. STUDY DESIGN:: Retrospective study. SETTING:: University hospital. PATIENTS:: Seventeen patients diagnosed with vestibular schwannoma between 2004 and 2011, and took part in vestibular PREHAB program. The patients were of age 21 to 66 years (mean 48.8), 9 females and 8 males. INTERVENTION:: Intratympanic gentamicin installations before surgery as part of the vestibular PREHAB. MAIN OUTCOME MEASURES:: Hearing thresholds, word recognition score, caloric response, subjective visual vertical and horizontal, cVEMP, and vestibular impulse tests. RESULTS:: Combined analysis of frequency and hearing threshold showed a significant decrease after gentamicin therapy (p &lt;0.001). Pure-tone average decreased with 7.1 ± 8.5 dB (p = 0.004), and speech recognition with 10%. The treatment resulted in unilateral vestibular deafferentation with no notable reaction to bithermal caloric irrigation (reduction 64%, p &lt;0.001), loss of the vestibulo-ocular response measured by the head-impulse test, and deviation of subjective horizontal/vertical to the side of the lesion (+2.2 degrees, p = 0.010). CONCLUSIONS:: Intratympanic installations of gentamicin, as part of the vestibular PREHAB, result in unilateral vestibular deafferentation, but constitute a definite risk for high-frequency hearing loss. The hearing results are in line with those reported upon when treating Menière’s disease.</p>},
  author       = {Tjernström, Fredrik and Fransson, Per Anders and Kahlon, Babar and Karlberg, Mikael and Lindberg, Sven and Siesjö, Peter and Magnusson, Måns},
  issn         = {0196-0202},
  language     = {eng},
  month        = {07},
  number       = {6},
  pages        = {744--750},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Ear and Hearing},
  title        = {Hearing and Vestibular Function After Preoperative Intratympanic Gentamicin Therapy for Vestibular Schwanomma as Part of Vestibular Prehab},
  url          = {http://dx.doi.org/10.1097/AUD.0000000000000340},
  volume       = {37},
  year         = {2016},
}