Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden.
Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
PLoS One. 2024 Jun 14;19(6):e0304184. doi: 10.1371/journal.pone.0304184. eCollection 2024.
Vestibular schwannoma can cause vestibular dysfunction; however, conflicting evidence exists regarding whether this affects the incidence of fall-related injuries in this patient population. This matched cross-sectional and cohort study assess the risk of fall-related injuries in patients with vestibular schwannoma. The study included patients with vestibular schwannoma treated at a tertiary referral hospital in Sweden between 1988 and 2014. Information on fall-related injuries was obtained from the National Patient Register, and matched population comparisons were randomly selected in a 1:25 ratio. Fall-related injuries occurring pre- (within 5 years before the diagnosis of vestibular schwannoma) and post-diagnostically (up to 3 years after diagnosis or intervention) were registered. The association between vestibular schwannoma and fall-related injuries was estimated using logistic regression and Cox proportional hazards analyses. We identified 1153 patients with vestibular schwannoma (569 [49%] women and 584 [51%] men), and 28815 population comparisons. Among the patients, 9% and 7% had pre- and post-diagnostic fall-related injuries, respectively, and among the comparisons, 8% and 6% had pre- and post-diagnostic fall-related injuries, respectively. There was no increased risk of pre- (OR 1.14; CI 0.92-1.41) or post-diagnostic 1 year (HR 1.16; CI 0.87-1.54) or 3 years (HR 1.11; CI 0.89-1.29) fall-related injury among the total patient cohort. In age-stratified analyses, we found an increased risk of pre-diagnostic fall-related injury among patients aged 50-69 years (OR 1.42; CI 1.10-1.88). Patients who underwent middle fossa surgery, regardless of age, had an increased risk of post-surgery fall-related injury within 3 years of follow-up (HR 2.68; CI 1.06-6.81). We conclude that patients with vestibular schwannoma have a low risk of enduring fall-related injuries. Middle-aged patients with dizziness and fall-related injuries should be considered for a vestibular clinical evaluation. Our results highlight the importance of rehabilitation in avoiding future fall-related injuries among patients undergoing middle fossa surgery.
前庭神经鞘瘤可引起前庭功能障碍；然而，目前对于这种功能障碍是否会影响该患者人群中跌倒相关损伤的发生率，还存在相互矛盾的证据。这项匹配的横断面和队列研究评估了前庭神经鞘瘤患者跌倒相关损伤的风险。该研究纳入了 1988 年至 2014 年在瑞典一家三级转诊医院接受治疗的前庭神经鞘瘤患者。跌倒相关损伤的信息来自国家患者登记处，并以 1:25 的比例随机选择人群进行匹配。登记了在诊断前庭神经鞘瘤前（诊断前 5 年内）和诊断后（诊断后 3 年内或干预后）发生的跌倒相关损伤。使用逻辑回归和 Cox 比例风险分析估计前庭神经鞘瘤与跌倒相关损伤之间的关联。我们确定了 1153 名前庭神经鞘瘤患者（569 名女性和 584 名男性）和 28815 名人群比较。在患者中，分别有 9%和 7%发生了诊断前和诊断后跌倒相关损伤，在比较中，分别有 8%和 6%发生了诊断前和诊断后跌倒相关损伤。在整个患者队列中，诊断前（OR 1.14；95%CI 0.92-1.41）或诊断后 1 年（HR 1.16；95%CI 0.87-1.54）或 3 年（HR 1.11；95%CI 0.89-1.29）跌倒相关损伤的风险均无增加。在年龄分层分析中，我们发现 50-69 岁患者诊断前跌倒相关损伤的风险增加（OR 1.42；95%CI 1.10-1.88）。无论年龄大小，接受中颅窝手术的患者在随访 3 年内发生术后跌倒相关损伤的风险增加（HR 2.68；95%CI 1.06-6.81）。我们的结论是，前庭神经鞘瘤患者发生跌倒相关损伤的风险较低。出现头晕和跌倒相关损伤的中年患者应考虑进行前庭临床评估。我们的结果强调了康复在避免中颅窝手术后患者发生未来跌倒相关损伤中的重要性。
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