Ochal-Choińska Aleksandra, Lachowska Magdalena, Kurczak Katarzyna, Niemczyk Kazimierz
Department of Otolaryngology, Medical University of Warsaw, Poland.
Center for Foreign Languages, Medical University of Warsaw, Poland.
Adv Clin Exp Med. 2019 Jun;28(6):747-757. doi: 10.17219/acem/90768.
Postoperative hearing loss after vestibular schwannoma (VS) removal still remains a lifelong problem for the patients. The present study analyzes the problem of hearing preservation after VS removal from a different angle than available professional literature on this topic.
To identify audiologic factors which determine the extent of hearing loss in patients operated on for VS.
The study group included 86 patients operated on due to VS accessed via the middle cranial fossa. The analyses involved the effect on absolute hearing loss, which was calculated on the basis of the results of pure-tone audiometry performed preand postoperatively, and factors included in the preoperative audiologic tests, such as pure-tone audiometry, speech audiometry, auditory brainstem response (ABR), and impedance audiometry.
The following parameters were demonstrated to have a prognostic value: 1. hearing thresholds at 125 Hz, 500 Hz and 1,000 Hz for the operated ear, Pure Tone Average (PTA) - calculated specifically at 500 Hz, 1,000 Hz and 2,000 Hz and at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz for the operated ear, and normal audiometric curve; 2. speech discrimination ranging from 55 dB to 75 dB for the operated ear, speech detection threshold (SDT) in the operated ear and interaural difference at 25-35 dB (non-operated vs operated ear); 3. presence of wave V, the values of I-V and III-V intervals for the operated ear, the amplitude of wave V, and the interaural ratio of wave V amplitudes; 4. intensity level for obtaining stapedial reflex or an abnormal reflex at Ipsi 500 Hz, 1,000 Hz and 2,000 Hz, and Contra 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz.
The better the preoperative hearing status, the more substantial surgery-related hearing loss was observed. A number of preoperative parameters of the basic diagnostic set of audiologic tests present a prognostic value for the degree of surgery-related hearing loss in VS patients.
前庭神经鞘瘤（VS）切除术后的听力损失对患者来说仍然是一个终身问题。本研究从与该主题现有专业文献不同的角度分析了VS切除术后的听力保留问题。
确定决定VS手术患者听力损失程度的听力学因素。
研究组包括86例因VS经中颅窝入路手术的患者。分析涉及对绝对听力损失的影响，绝对听力损失是根据术前和术后纯音听力测试结果计算得出的，还包括术前听力学测试中的各项因素，如纯音听力测试、言语听力测试、听性脑干反应（ABR）和声阻抗测听。
以下参数被证明具有预后价值：1. 患侧耳在125Hz、500Hz和1000Hz的听力阈值，纯音平均听阈（PTA）——专门在500Hz、1000Hz和2000Hz计算，以及患侧耳在500Hz、1000Hz、2000Hz和4000Hz的纯音平均听阈，和正常听力曲线；2. 患侧耳在55dB至75dB之间的言语辨别率，患侧耳的言语察觉阈（SDT）以及在25 - 35dB时的双耳差值（健侧耳与患侧耳）；3. 患侧耳V波的存在、I - V和III - V间期的值、V波的振幅以及V波振幅的双耳比值；4. 在同侧500Hz、1000Hz和2000Hz以及对侧500Hz、1000Hz、2000Hz和4000Hz获得镫骨肌反射或异常反射的强度水平。
术前听力状况越好，观察到的与手术相关的听力损失就越严重。听力学基本诊断测试的一些术前参数对VS患者与手术相关的听力损失程度具有预后价值。
