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Lin Chuang Er Bi Yan Hou Tou Jing Wai... Dec 2022This study was conducted to evaluate the applications of vestibular function tests in diagnosis, identifying tumor origins and prognosis of vestibular rehabilitation of...
This study was conducted to evaluate the applications of vestibular function tests in diagnosis, identifying tumor origins and prognosis of vestibular rehabilitation of patients with acoustic neuroma. This research is a single-center cross-sectional clinical study, which retrospectively analyzed the data of 335 patients with acoustic neuroma from March 2013 to March 2020 in the Eye and ENT Hospital of Fudan University. The study included caloric test, cervical and ocular vestibular evoked myogenic potentials(cVEMP, oVEMP), video head impulse test(vHIT) and sensory organization test(SOT). Firstly, the sensitivity, specificity, and Yoden index of each test were calculated. Secondly, the internal relevance of these tests was studied for application in judging the origins of the tumor. The abnormal rates of caloric test, cVEMP, oVEMP, vHIT and SOT was 85.3%, 86.1%, 85.5%, 55.6% and 67.7% in these participants. Among all the vestibular function tests included, the caloric test showed the best sensitivity(0.855), specificity(0.981), and Yoden index(0.836). The study found that the higher the Koos grades, the higher the abnormal rates of the caloric test, vHIT, and oVEMP(Cochran-Armitage test, <0.05). There was no significant relationship between the combination of abnormal vestibular function tests and tumor origin nerves(>0.05). Majorlty of the participants in this study with acoustic neuroma showed abnormal results in SOT related to poor balance control. More than half of the patients had at least two abnormal result of the battery of vestibular function tests, among which the caloric test was proved to have better sensitivity and specificity. The higher the Koos grades of the tumor, the higher the abnormal rates of the caloric test, vHIT, and oVEMP.
Topics: Humans; Neuroma, Acoustic; Retrospective Studies; Cross-Sectional Studies; Vestibular Function Tests; Caloric Tests; Vestibular Evoked Myogenic Potentials; Head Impulse Test
PubMed: 36543397
DOI: 10.13201/j.issn.2096-7993.2022.12.004 -
Mathematical Biosciences and... Jul 2022Acoustic neuroma is a common benign tumor that is frequently associated with postoperative complications such as facial nerve dysfunction, which greatly affects the...
Acoustic neuroma is a common benign tumor that is frequently associated with postoperative complications such as facial nerve dysfunction, which greatly affects the physical and mental health of patients. In this paper, clinical data of patients with acoustic neuroma treated with microsurgery by the same operator at Xiangya Hospital of Central South University from June 2018 to March 2020 are used as the study object. Machine learning and SMOTE-ENN techniques are used to accurately predict postoperative facial nerve function recovery, thus filling a gap in auxiliary diagnosis within the field of facial nerve treatment in acoustic neuroma. First, raw clinical data are processed and dependent variables are identified based on clinical context and data characteristics. Secondly, data balancing is corrected using the SMOTE-ENN technique. Finally, XGBoost is selected to construct a prediction model for patients' postoperative recovery, and is also compared with a total of four machine learning models, LR, SVM, CART, and RF. We find that XGBoost can most accurately predict the postoperative facial nerve function recovery, with a prediction accuracy of 90.0% and an AUC value of 0.90. CART, RF, and XGBoost can further select the more important preoperative indicators and provide therapeutic assistance to physicians, thereby improving the patient's postoperative recovery. The results show that machine learning and SMOTE-ENN techniques can handle complex clinical data and achieve accurate predictions.
Topics: Facial Nerve; Humans; Machine Learning; Neuroma, Acoustic; Postoperative Complications; Postoperative Period
PubMed: 36032000
DOI: 10.3934/mbe.2022487 -
The Journal of International Medical... Feb 2020Sudden sensorineural hearing loss (SSNHL) is a relatively rare, but distressing, disease in pregnant women. Little is known about the causes, clinical manifestations,... (Review)
Review
Sudden sensorineural hearing loss (SSNHL) is a relatively rare, but distressing, disease in pregnant women. Little is known about the causes, clinical manifestations, treatments, and prognosis of SSNHL. Some hypotheses have been proposed to explain the pathophysiological mechanism of SSNHL, but most of them have not been identified. This article reviews the existing literature to present a summary of this clinical problem. Most patients suffer from SSNHL in the second or third trimester, and show moderate to profound hearing loss. The interval between the initial treatment and onset of hearing loss is less than 10 days in most patients. Some patients with SSNHL show tinnitus, vertigo, or dizziness, and fullness of the ear. Although some patients have a tendency for self-cure, treatment with intravenous dextran 40 combined with intratympanic corticosteroids is probably a safe and effective therapeutic strategy for pregnant patients with SSNHL. Further clinical research is necessary to identify the best therapeutic strategy for these patients.
Topics: Female; Hearing Loss, Sensorineural; Hearing Loss, Sudden; Humans; Pregnancy; Retrospective Studies; Tinnitus; Treatment Outcome; Vertigo
PubMed: 31452412
DOI: 10.1177/0300060519870718 -
Journal of Clinical Neuroscience :... Oct 2023Acoustic neuroma (AN) research largely employs a medical framework to understand health outcomes. An alternative is to examine quality of life (QOL) outcomes. This study...
INTRODUCTION
Acoustic neuroma (AN) research largely employs a medical framework to understand health outcomes. An alternative is to examine quality of life (QOL) outcomes. This study explored whether mental well-being (i.e., anxiety and depression) were predictive of QOL in those with AN over and above symptomatology.
METHODS
A nationwide online survey was distributed to 24 community organisations. The inclusion criteria were a diagnosis of AN irrespective of the treatment approach. There were 52 respondents. Mental well-being was assessed using the Hospital Anxiety and Depression Scale (HADS), and quality of life was assessed using Penn Acoustic Neuroma QOL scale (PANQOL).
RESULTS
The most frequently reported symptoms reported were poor balance, tinnitus, hearing loss, and headache. Preliminary analyses suggested that headaches, tinnitus and mental well-being were significantly correlated with QOL. Hierarchical regression revealed that these two symptoms and mental well-being accounted for 18.7% and 51.1% of the variance in QOL, respectively. In addition, there was a significant difference in depression scores between management types, with the surgery group having a significantly higher depression score than the radiation group.
CONCLUSION
Symptoms and mood contribute to QOL for those diagnosed with AN. This can be understood through the common-sense model and fear of cancer recurrence. Screening for psychological difficulties should be provided from the point of diagnosis to post-treatment to allow for targeted management plans to mitigate the effects of these on QOL.
Topics: Humans; Quality of Life; Neuroma, Acoustic; Tinnitus; Psychological Well-Being; Mental Health; Headache
PubMed: 37597328
DOI: 10.1016/j.jocn.2023.08.005 -
Annals of Translational Medicine Mar 2021Electrophysiological monitoring is used routinely to protect the facial nerve during acoustic neuroma surgery. This study aimed to clarify the relationship between the...
BACKGROUND
Electrophysiological monitoring is used routinely to protect the facial nerve during acoustic neuroma surgery. This study aimed to clarify the relationship between the facial nerve's electrophysiological monitoring parameters and its function after surgery.
METHODS
Fifty-two patients with acoustic neuroma who underwent surgery were included. After localizing the facial nerve, its monitoring results during surgeries performed at our center were analyzed. Postoperative nerve functioning was correlated with the stimulation threshold of the facial nerve's proximal segment, proximal-to-distal amplitude ratio of the facial nerve, and proximal stimulation amplitude. Receiver-operating characteristic curves of the three parameters were calculated.
RESULTS
Electrical stimulation accurately described the facial nerve's anatomic distribution after the depth of anesthesia was assessed via accessory nerve stimulation. The data recorded after resection showed that a higher proximal-to-distal amplitude ratio was associated with better facial nerve functioning (P=0.037). A lower stimulation threshold of the proximal segment correlated with better facial nerve functioning (P=0.038).
CONCLUSIONS
The most sensitive index to predict postoperative nerve functioning is the facial nerve's proximal-to-distal amplitude ratio. Accessory nerve stimulation can determine the appropriate depth of anesthesia, Electromyography (EMG) monitoring of the facial nerve during acoustic neuroma surgery can protect it effectively.
PubMed: 33842626
DOI: 10.21037/atm-20-6858 -
Otology & Neurotology : Official... Jun 2020In this review, we discuss current knowledge about the genetics and epigenetics of vestibular schwannoma (VS) in relation to hearing loss. A multistep and sequential... (Review)
Review
OBJECTIVES
In this review, we discuss current knowledge about the genetics and epigenetics of vestibular schwannoma (VS) in relation to hearing loss. A multistep and sequential genetic algorithm suitable for the identification of Neurofibromatosis Type 2 (NF2) constitutional and somatic mutations is discussed.
DATA SOURCES, STUDY SELECTION
A review was performed of the English literature from 1990 to 2019 using PubMed regarding genetics and epigenetics of vestibular schwannoma and NF2.
CONCLUSION
NF2 is a genetic disorder characterized by NF2 mutations that affect the function of a tumor suppressor called merlin. In particular, individuals with NF2 develop bilateral VS that can lead to hearing loss and even deafness. Recent advances in genetic and epigenetic studies have improved our understanding of the genotype-phenotype relationships that affect hearing in NF2 patients. Specific constitutional NF2 mutations including particular truncating, deletion, and missense mutations have been associated with poorer hearing outcomes and more severe clinical manifestations. Epigenetic events, such as DNA methylation and histone modifications, also contribute to the development and progression of hearing loss in NF2 patients. Furthermore, the accumulation of multiple NF2 and non-NF2 genetic and epigenetic abnormalities at the level of the tumor may contribute to worse hearing outcomes. Understanding genetic and epigenetic signatures in individual NF2 patients and particularly in each VS will allow us to develop novel gene therapies and precision medicine algorithms to preserve hearing in NF2 individuals.
Topics: Epigenesis, Genetic; Genes, Neurofibromatosis 2; Genomics; Hearing Loss; Humans; Neurofibromatosis 2; Neuroma, Acoustic
PubMed: 32150022
DOI: 10.1097/MAO.0000000000002613 -
Acta Otorhinolaryngologica Italica :... Apr 2023translate and validate the Penn Acoustic Neuroma Quality of Life Scale into Italian language (PANQOL-It).
OBJECTIVE
translate and validate the Penn Acoustic Neuroma Quality of Life Scale into Italian language (PANQOL-It).
METHODS
the instrument was translated and psychometric properties were subsequently assessed by administering the PANQOL-It to 124 outpatients together with the Depression Anxiety Stress Scale (DASS21) and the Understanding and Communicating domain of the World Health Organization Disability Assessment Schedule II (WHODAS II-D1). The internal consistency, test-retest reliability, construct and criterion-related validity were assessed.
RESULTS
Cronbach's alpha coefficient was 0.92 for the total score and ranged from 0.44 to 0.90 in the seven domains. Significant test-retest reliability was observed (intraclass-correlation = 0.75; p < 0.01). Moderate correlation was reported between facial dysfunction domain and objective facial involvement (p < 0.01). Moderate to strong correlations were observed between anxiety, general health domains and all subscales of the DASS21, and between WHODAS II-D1 and general health and energy domains (p < 0.01). These latter results indicated good construct and criterion-related validity respectively.
CONCLUSIONS
PANQOL-It presented more than acceptable psychometric properties and its adoption is justified for both clinical and research purposes.
Topics: Humans; Neuroma, Acoustic; Quality of Life; Reproducibility of Results; Language; Italy; Surveys and Questionnaires
PubMed: 37099437
DOI: 10.14639/0392-100X-N2263 -
Neurosurgery Jun 2023Stereotactic radiosurgery (SRS) is one of the main treatment options in the management of small to medium size vestibular schwannomas (VSs), because of high tumor... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Stereotactic radiosurgery (SRS) is one of the main treatment options in the management of small to medium size vestibular schwannomas (VSs), because of high tumor control rate and low cranial nerves morbidity. Series reporting long-term hearing outcome (>3 years) are scarce.
OBJECTIVE
To perform a systematic review of the literature and meta-analysis, with the aim of focusing on long-term hearing preservation after SRS.
METHODS
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we reviewed articles published between January 1990 and October 2020 and referenced in PubMed or Embase. Inclusion criteria were peer-reviewed clinical study or case series of VSs treated with SRS (single dose), reporting hearing outcome after SRS with a median or mean audiometric follow-up of at least 5 years. Hearing preservation, cranial nerves outcomes, and tumor control were evaluated.
RESULTS
Twenty-three studies were included. Hearing preservation was found in 59.4% of cases (median follow-up 6.7 years, 1409 patients). Main favorable prognostic factors were young age, good hearing status, early treatment after diagnosis, small tumor volume, low marginal irradiation dose, and maximal dose to the cochlea. Tumor control was achieved in 96.1%. Facial nerve deficit and trigeminal neuropathy were found in 1.3% and 3.2% of patients, respectively, both significantly higher in Linear Accelerator series than Gamma Knife series ( P < .05).
CONCLUSION
Long-term hearing preservation remains one of the main issues after SRS, with a major impact on health-related quality of life. Our meta-analysis suggests that hearing preservation can be achieved in almost 60% of patients after a median follow-up of 6.7 years, irrespective of the technique.
Topics: Humans; Neuroma, Acoustic; Radiosurgery; Treatment Outcome; Quality of Life; Hearing; Follow-Up Studies; Retrospective Studies
PubMed: 36735500
DOI: 10.1227/neu.0000000000002354 -
Frontiers in Neuroscience 2023Acoustic neuroma is one of the most common tumors in the cerebellopontine angle area. Patients with acoustic neuroma have clinical manifestations of the cerebellopontine...
Acoustic neuroma is one of the most common tumors in the cerebellopontine angle area. Patients with acoustic neuroma have clinical manifestations of the cerebellopontine angle occupying syndrome, such as tinnitus, hearing impairment and even hearing loss. Acoustic neuromas often grow in the internal auditory canal. Neurosurgeons need to observe the lesion contour with the help of MRI images, which not only takes a lot of time, but also is easily affected by subjective factors. Therefore, the automatic and accurate segmentation of acoustic neuroma in cerebellopontine angle on MRI is of great significance for surgical treatment and expected rehabilitation. In this paper, an automatic segmentation method based on Transformer is proposed, using TransUNet as the core model. As some acoustic neuromas are irregular in shape and grow into the internal auditory canal, larger receptive fields are thus needed to synthesize the features. Therefore, we added Atrous Spatial Pyramid Pooling to CNN, which can obtain a larger receptive field without losing too much resolution. Since acoustic neuromas often occur in the cerebellopontine angle area with relatively fixed position, we combined channel attention with pixel attention in the up-sampling stage so as to make our model automatically learn different weights by adding the attention mechanism. In addition, we collected 300 MRI sequence nuclear resonance images of patients with acoustic neuromas in Tianjin Huanhu hospital for training and verification. The ablation experimental results show that the proposed method is reasonable and effective. The comparative experimental results show that the Dice and Hausdorff 95 metrics of the proposed method reach 95.74% and 1.9476 mm respectively, indicating that it is not only superior to the classical models such as UNet, PANet, PSPNet, UNet++, and DeepLabv3, but also show better performance than the newly-proposed SOTA (state-of-the-art) models such as CCNet, MANet, BiseNetv2, Swin-Unet, MedT, TransUNet, and UCTransNet.
PubMed: 37292160
DOI: 10.3389/fnins.2023.1207149 -
Higher Prevalence and Age Susceptibility of Intracranial Aneurysm in Patients With Acoustic Neuroma.Frontiers in Neurology 2020The purpose of this study was to verify whether the prevalence of intracranial aneurysm (IA) in patients with acoustic neuroma is greater than that in age- and...
The purpose of this study was to verify whether the prevalence of intracranial aneurysm (IA) in patients with acoustic neuroma is greater than that in age- and sex-matched controls and to evaluate the independent risk factors related to the occurrence of IA. We retrospectively analyzed 231 patients diagnosed with acoustic neuroma at our institute between 2015 and 2019 and 489 controls from the medical examination center. Cerebrovascular angiography was acquired from all subjects to assess the presence of IA or not. The prevalence of IA and risk factors associated with a higher IA occurrence were compared, respectively. Cerebral aneurysms were detected in 23 patients (10.0%) and 11 controls (2.2%). The prevalence of IA was significantly different between patients with acoustic neuroma and controls ( < 0.001), and the difference was mainly reflected in the age of 50 and above. In the subgroup analysis, there were distinct differences in several clinical features including age, hypertension, and tumor volume, and cystic change between patients coexisted with IA or not. However, age was a unique independent risk factor for coexistence of IA in patients with acoustic neuroma after multivariate logistic regression (OR 1.050, 95% CI 1.008-1.093, = 0.019). Our results demonstrate that patients with acoustic neuroma have a higher prevalence of IA than the general population. Older age is correlated with greater occurrence of IA in these patients.
PubMed: 33224100
DOI: 10.3389/fneur.2020.591526