Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands.
Otolaryngol Head Neck Surg. 2023 Sep;169(3):622-632. doi: 10.1002/ohn.277. Epub 2023 Feb 5.
This study evaluates the natural course of hearing loss (HL) prior to treatment in patients with progressive tumors and an indication for active intervention. Evaluating this patient group specifically can put hearing outcomes after vestibular schwannoma therapy into an adequate context.
Retrospective cohort study.
Tertiary referral center.
Inclusion criteria comprised unilateral vestibular schwannomas prior to active treatment, with ≥2 mm extracanalicular (EC) tumor growth and ≥2 audiograms. We performed a comprehensive assessment of hearing using multiple outcome parameters including (the annual decrease in) pure-tone averages (PTAs; an average of 0.5, 1, 2, and 3 kHz). Predictors for HL were evaluated (patient age, tumor size/progression, follow-up duration, baseline hearing).
At presentation, 86% of patients suffered from sensorineural HL on the affected side (≥20 dB PTA) with a median of 39 dB (interquartile rate [IQR]: 27-51 dB). The median follow-up duration was 21 months (IQR: 13-34 months), after which 58% (187/322) of patients experienced progressive HL (≥10 dB), with a median increase of 6.4 dB/year. At the last follow-up, the median PTA was 56 dB (IQR: 37-73). Median speech discrimination scores deteriorated from 90% (IQR: 70%-100%) to 65% (IQR: 35%-100%). Tumor progression (maximal EC diameter) was significantly correlated to the progression of sensorineural HL, corrected for follow-up (F(2,228) = 10.4, p < .001, R = 8%).
The majority of patients (58%) with radiologically confirmed progressive vestibular schwannomas experience progressive sensorineural HL during observation. Tumor progression rate, EC tumor extension, and longer follow-up are factors associated with more sensorineural HL.
本研究评估了有治疗指征的进行性肿瘤患者在治疗前听力损失（HL）的自然病程。专门评估这一患者群体可以使听神经鞘瘤治疗后的听力结果更为合理。
回顾性队列研究。
三级转诊中心。
纳入标准包括单侧前庭神经鞘瘤，在积极治疗前有≥2mm的管外（EC）肿瘤生长和≥2次听力测试。我们使用多个结果参数（包括纯音平均值[PTA]的年下降率[平均 0.5、1、2 和 3kHz]）对听力进行全面评估。评估了 HL 的预测因素（患者年龄、肿瘤大小/进展、随访时间、基线听力）。
就诊时，86%的患者患侧（PTA≥20dB）有感觉神经性 HL，中位数为 39dB（四分位距[IQR]：27-51dB）。中位随访时间为 21 个月（IQR：13-34 个月），此后 58%（187/322）的患者出现进行性 HL（≥10dB），中位数每年增加 6.4dB。在最后一次随访时，PTA 的中位数为 56dB（IQR：37-73）。中位言语辨别率从 90%（IQR：70%-100%）下降至 65%（IQR：35%-100%）。肿瘤进展（最大 EC 直径）与感觉神经性 HL 的进展显著相关，经随访校正（F（2,228）=10.4，p<0.001，R2=8%）。
在有影像学证实的进行性听神经鞘瘤患者中，大多数患者（58%）在观察期间出现进行性感觉神经性 HL。肿瘤进展率、EC 肿瘤延伸和更长的随访时间是与更多感觉神经性 HL 相关的因素。
