Caye-Thomasen Per, Dethloff Thomas, Hansen Søren, Stangerup Sven-Eric, Thomsen Jens
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Gentofte University Hospital of Copenhagen, Copenhagen, Denmark.
Audiol Neurootol. 2007;12(1):1-12. doi: 10.1159/000096152. Epub 2006 Oct 10.
This paper reports data on the spontaneous course of hearing in 156 patients with purely intracanalicular vestibular schwannomas. The mean pure tone average (PTA) was 51 dB HL and the mean speech discrimination score (SDS) 60% at diagnosis. The risk of a significant subsequent hearing loss (>or=10 dB PTA or >or=10% SDS) was 54% during 4.6 years of observation. Patients with normal speech discrimination at diagnosis had a significantly smaller risk of loosing hearing. The hearing loss at diagnosis and during observation was not related to age, gender, diagnostic tumor size, tumor- induced expansion of the internal auditory canal or tumor sublocalization (fundus, central or porus). However, the loss of PTA was smaller in shrinking tumors and the PTA deterioration rate correlated with the volumetric tumor growth rate. After 4.6 years observation, the PTA had increased by 14 dB to 65 dB HL, and the SDS reduced by 17% to 43%. The proportion of patients eligible for hearing preservation treatment as determined by word recognition score class I (70-100% SDS) was reduced to 28% (a 44% reduction), and by AAO-HNS class A to 9% (a 53% reduction).
本文报告了156例纯内听道型前庭神经鞘瘤患者听力的自然病程数据。诊断时平均纯音听阈（PTA）为51dB HL，平均言语识别率（SDS）为60%。在4.6年的观察期内，随后出现显著听力损失（PTA≥10dB或SDS≥10%）的风险为54%。诊断时言语识别正常的患者听力丧失风险显著较小。诊断时及观察期间的听力损失与年龄、性别、诊断时肿瘤大小、肿瘤引起的内听道扩大或肿瘤定位（底部、中央或孔口）无关。然而，肿瘤缩小的患者PTA损失较小，且PTA恶化率与肿瘤体积生长率相关。经过4.6年的观察，PTA增加了14dB至65dB HL，SDS降低了17%至43%。根据言语识别评分I级（SDS 70 - 100%）确定适合听力保留治疗的患者比例降至28%（降低了44%），根据美国耳鼻咽喉头颈外科学会（AAO - HNS）A类标准降至9%（降低了53%）。
