Fik Zdenek, Lazak Jan, Hruba Silvie, Cada Zdenek, Zverrna Eduard, Betka Jan
Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol, V Uvalu 84, 150 06, Prague 5, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2022 Sep;166(3):347-352. doi: 10.5507/bp.2021.067. Epub 2021 Dec 9.
Hearing preservation after vestibular schwannoma (VS) surgery remains a surgical challenge. In some patients with preserved inner ear function, hearing improvement is achievable. As it is currently impossible to determine which patients will present this outcome, predictions must rely on previously published reports. Our case report describes a patient who experienced hearing improvement from an unuseful level to a useful one after vestibular schwannoma surgery.
Surgery was performed via suboccipital retrosigmoid approach. The patient underwent a basic audiovestibular protocol before and after the surgery - pure tone and speech audiometry, otoacoustic emissions, auditory brainstem responses, electronystagmography - together with a detailed questionnaire study. Usefulness of hearing was evaluated using the AAO-HNS guidelines, supplemented by a frequency of 4 kHz.
Hearing was preserved and even improved from an unuseful level to a useful one. Based on the available literature, the most informative predictive factors for such a result seem to be: sudden sensorineural hearing loss prior to surgery, elicitable otoacoustic emissions and the origin from the superior vestibular nerve.
There are a limited number of studies on this topic and it is still impossible to regularly improve hearing in properly selected patients. Furthermore, the importance of postoperative hearing quality compared to other symptoms and complications remains debatable.
前庭神经鞘瘤（VS）手术后听力保留仍然是一项手术挑战。在一些内耳功能保留的患者中，听力改善是可以实现的。由于目前无法确定哪些患者会出现这种结果，预测必须依赖以前发表的报告。我们的病例报告描述了一名患者，其在接受前庭神经鞘瘤手术后听力从无实用价值提升至有实用价值。
通过枕下乙状窦后入路进行手术。患者在手术前后接受了基本的听前庭检查方案——纯音和言语听力测定、耳声发射、听觉脑干反应、眼震电图——以及详细的问卷调查研究。使用美国耳鼻咽喉头颈外科学会（AAO-HNS）指南并补充4kHz频率来评估听力的实用性。
听力得以保留，甚至从无实用价值提升至有实用价值。根据现有文献，对于这种结果最具信息价值的预测因素似乎是：术前突发感音神经性听力损失、可引出的耳声发射以及起源于上前庭神经。
关于这个主题的研究数量有限，仍然无法在适当选择的患者中常规性地改善听力。此外，与其他症状和并发症相比，术后听力质量的重要性仍存在争议。
