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American Journal of Otolaryngology 2022Vestibular schwannoma is a benign tumor in the schwannoma cells of the 8th cranial nerve. It causes symptoms like tinnitus, vertigo and end up with loss of hearing so... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Vestibular schwannoma is a benign tumor in the schwannoma cells of the 8th cranial nerve. It causes symptoms like tinnitus, vertigo and end up with loss of hearing so the appropriate treatment is very important. There are many treatment techniques including conservative, surgery and radiosurgery. We aimed to systematically review and single arm meta-analysis the different treatment techniques of vestibular schwannoma.
METHODS
A comprehensive literature search using thirteen databases including PubMed, Scopus, and Web of Science was performed. All clinical trials about treatment vestibular schwannoma were included and single arm meta-analyzed. We assessed the risk of bias using ROBIN-I's tool and scale of Council Australia's Cancer Guidelines Wiki. The protocol was registered in PROSPERO (CRD42018089784) and has been updated on 17 April 2019.
RESULTS
A total of 35 clinical trials studies were included in the final analysis. The pooled proportion of stable hearing capability in patients receiving gamma knife radiosurgery (GKRS) was 64% (95% CI: 52%-74%). GKRS favored increased hearing capability 10% (95% CI: 7%-16%). Regarding tumor size, GKRS is the most protective method 53% (95% CI: 37%-69%). Complications occurred most commonly in single fractional linac stereotactic radiosurgery (SFSRT) 37% (95% CI: 12%-72%).
CONCLUSION
Our analysis suggested gamma knife radiosurgery could be the most ideal treatment for vestibular schwannoma based on stabilizing hearing capability, increasing hearing capability, decreasing tumor size and complications.
Topics: Hearing; Hearing Tests; Humans; Neuroma, Acoustic; Radiosurgery; Treatment Outcome
PubMed: 34973662
DOI: 10.1016/j.amjoto.2021.103337 -
The American Journal of Occupational... 2016This systematic review evaluates the effectiveness of sensory stimulation to improve arousal and alertness of people in a coma or persistent vegetative state after... (Review)
Review
Effectiveness of Sensory Stimulation to Improve Arousal and Alertness of People in a Coma or Persistent Vegetative State After Traumatic Brain Injury: A Systematic Review.
OBJECTIVE
This systematic review evaluates the effectiveness of sensory stimulation to improve arousal and alertness of people in a coma or persistent vegetative state after traumatic brain injury (TBI).
METHOD
Databases searched included Medline, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. The search was limited to outcomes studies published in English in peer-reviewed journals between 2008 and 2013.
RESULTS
Included studies provide strong evidence that multimodal sensory stimulation improves arousal and enhances clinical outcomes for people in a coma or persistent vegetative state after TBI. Moderate evidence was also provided for auditory stimulation, limited evidence was provided for complex stimuli, and insufficient evidence was provided for median nerve stimulation.
CONCLUSION
Interventions should be tailored to client tolerance and premorbid preferences. Bimodal or multimodal stimulation should begin early, be frequent, and be sustained until more complex activity is possible.
Topics: Acoustic Stimulation; Arousal; Brain Injuries; Coma; Early Medical Intervention; Humans; Outcome Assessment, Health Care; Persistent Vegetative State; Physical Stimulation; Sensation
PubMed: 27089287
DOI: 10.5014/ajot.2016.021022 -
The Laryngoscope Feb 2016Postthyroidectomy voice changes are common even without apparent laryngeal nerve injury. Our study evaluated the impact of open cervical thyroidectomy on five acoustic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postthyroidectomy voice changes are common even without apparent laryngeal nerve injury. Our study evaluated the impact of open cervical thyroidectomy on five acoustic voice parameters in the early (< 3 months) and late (≥ 3 months) postoperative periods.
METHODS
A systematic review was performed to identify studies that quantitatively assessed voice quality by acoustic voice analysis before and after thyroidectomy. Parameters included average fundamental frequency (F0 , Hz), jitter (%), shimmer (%), noise-to-harmonic ratio (NHR), and maximum phonation time (MPT) (in secs). Meta-analysis was performed using both fixed- and random-effects models.
RESULTS
A total of 896 patients were analyzed. Relative to baseline, F0 significantly worsened in the early period (from 194.9 ± 34.9 Hz to 188.0 ± 34.0 Hz, P = 0.001). This was equivalent to a quarter-tone loss (P = 0.004). Shimmer (from 3.15 ± 1.59% to 3.19 ± 1.70%, P = 0.040) and MPT (from 17.9 secs to 16.7 secs, P = 0.046) also worsened in the early period, whereas jitter and NHR remained unchanged in the early and late periods. Males suffered greater deterioration in F0 (from 120.6 ± 18.8 Hz to 111.0 ± 18.5 Hz, P = 0.048) and in NHR (from 0.12 ± 0.02 to 0.16 ± 0.03, P = 0.019) than females in the early period. Four of the five acoustic parameters (F0 , jitter, shimmer, and NHR) significantly worsened after total thyroidectomy (TT) and not after lesser resection.
CONCLUSION
F0 , shimmer, and MPT significantly worsened in the early and not in the late postoperative period. F0 impairment was perceptually significant. Males and those undergoing TT suffered greater voice impairment than their counterparts during the early period.
Topics: Acoustics; Female; Humans; Male; Postoperative Period; Thyroidectomy; Voice; Voice Disorders; Voice Quality
PubMed: 26152841
DOI: 10.1002/lary.25452 -
Otology & Neurotology : Official... Jul 2021Nimodipine has emerged as a promising strategy for protection of cranial nerves following vestibular schwannoma (VS) resections. Our goal was to conduct a comprehensive... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Nimodipine has emerged as a promising strategy for protection of cranial nerves following vestibular schwannoma (VS) resections. Our goal was to conduct a comprehensive analysis of clinical studies to determine the therapeutic efficacy of nimodipine in improving facial nerve and cochlear nerve function.
DATABASE REVIEWED
We searched PubMed, Scopus, Cochrane Clinical Trial Registry, Clinicaltrials.gov, World Health Organization's International Clinical Trials Registry Platform, and EU Clinical Trials Registry to identify clinical studies up to May 11, 2020.
METHODS
We included studies evaluating perioperative administration of nimodipine as a strategy to prevent or treat facial nerve or cochlear nerve dysfunction following VS resections. Primary outcomes included preservation or recovery of House-Brackman scale for facial nerve function and Hearing and Equilibrium Guidelines for cochlear nerve function at the latest follow-up visit. Secondary outcomes included adverse events and administration strategies of nimodipine.
RESULTS
Nine studies (603 patients) met inclusion, of which seven studies (559 patients) were included in the quantitative analysis. Overall, nimodipine significantly increased the odds of cranial nerve recovery compared with controls (odds ratio [OR] 2.87, 95% confidence intervals [CI] [2.08, 3.95]; I2 = 0%). Subgroup analysis demonstrated that nimodipine was only effective for cochlear nerve preservation (OR 2.78, 95% CI [1.74, 4.45]; I2 = 0%), but not for facial nerve function (OR 4.54, 95% CI [0.25, 82.42]; I2 = 33%).
CONCLUSION
Although there is evidence supporting the perioperative role of nimodipine for VS resections, more studies are warranted to help clarify the effects of nimodipine therapy on cranial nerve preservation.
Topics: Cochlear Nerve; Facial Nerve; Hearing; Hearing Tests; Humans; Nimodipine
PubMed: 33710143
DOI: 10.1097/MAO.0000000000003101 -
Journal of Clinical Neuroscience :... May 2024Facial nerve hemangiomas (FNHs) are rare tumors that primarily occur near the geniculate ganglion in the temporal bone. Despite their rarity, they can cause significant... (Review)
Review
BACKGROUND
Facial nerve hemangiomas (FNHs) are rare tumors that primarily occur near the geniculate ganglion in the temporal bone. Despite their rarity, they can cause significant facial nerve dysfunction. The optimal management approach for FNHs remains uncertain, with surgery being the mainstay but subject to debate regarding the extent of resection and preservation of the facial nerve.
METHODS
Systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried the PubMed/Medline (accessed on 5 March 2024) electronic database using combinations of the following search terms and words text: "geniculate ganglion hemangioma", "ganglional hemangioma", "hemangioma of the facial nerve", "facial hemangioma", and "intratemporal hemangioma".
RESULTS
We identified a total of 30 literatures (321 patients). The most common site involved for the facial nerve hemangioma was the geniculate ganglion area followed by internal auditory canal, tympanic segment, labyrinthine segment and mastoid involvement. All patients were treated with conservative management or surgery. We report a 48-year-old female patient with HB grade 2 facial palsy and hemifacial spasm underwent SRS using Cyberknife technology. The treatment targeted the FNH in the left internal acoustic canal near the geniculate ganglion. Six months post-treatment, clinical improvement was evident, and lesion control was confirmed in a follow-up brain MRI.
CONCLUSION
The rarity of FNHs contributes to the lack of consensus on optimal management. This illustrative case demonstrates the feasibility of SRS as a standalone treatment for FNHs.
PubMed: 38823231
DOI: 10.1016/j.jocn.2024.05.023 -
Laryngoscope Investigative... Oct 2023To systematically review the prevalence and risk factors of inadvertent facial nerve stimulation (FNS) after cochlear implant (CI) surgery. And to report the different... (Review)
Review
OBJECTIVES
To systematically review the prevalence and risk factors of inadvertent facial nerve stimulation (FNS) after cochlear implant (CI) surgery. And to report the different management strategies used for reducing and resolving FNS.
DATA SOURCE
Web of Science, Scopus, PubMed, Cochrane Library, and Virtual Health Library (VHL) of the World Health Organization (WHO).
REVIEW METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) on studies that reported FNS as a complication after CI. A comprehensive electronic search strategy was used to identify the relevant articles. We extracted the data on the prevalence of FNS after CI activation, the reported grades, and the management strategies. The number of associated electrodes; cause of deafness; co-anomalies; and duration of hearing loss and their relationships with FNS were also studied.
RESULTS
Twenty-one relevant articles were included in this review. The prevalence of FNS among the CI populations was 5.29% (175/3306 patients). Among those whose ages were reported, 58.3% (95/163) were adults, and 41.7% (68/163) were pediatrics. Modifying the different fitting parameters was the most used strategy, as it successfully resolved FNS in 85.5% of the patients (142/166). The second commonly used management strategy was surgical intervention (reimplantation or explantation), which was reported in seven studies for 23 patients.
CONCLUSION
FNS after CI activation could be controlled and resolved with many advances that range from readjusting the fitting parameters to surgical intervention. However, further studies are required to validate the efficacy of each management strategy and its impact on patients' performance. Our findings demonstrate that CI recipients with FNS could still benefit from the CI devices and their FNS could be controlled.
PubMed: 37899846
DOI: 10.1002/lio2.1121 -
Cureus Nov 2023The facial nerve is the seventh of 12 cranial nerves found in the head and neck region that facilitates several nerve fibers and pathways to perform various functions.... (Review)
Review
The facial nerve is the seventh of 12 cranial nerves found in the head and neck region that facilitates several nerve fibers and pathways to perform various functions. Iatrogenic facial nerve injury during surgeries of the head and neck is common, ranging from 4-6%, particularly in procedures that involve mobilization or resection of associated anatomical structures. Any injury to the facial nerve or its branches impacts the quality of life and patient satisfaction as the degree of iatrogenic injury may result in partial or complete facial nerve paralysis. Of the various implementable techniques available to avoid injury, electromyography (EMG) has recently been widely used to monitor facial nerve function intraoperatively to determine the degree of injury and predict postoperative weakness. The purpose of this study was to analyze and review existing scientific literature in determining the role of intraoperative facial nerve monitoring (IFNM) with EMG in decreasing the incidence and degree of intraoperative facial nerve injury among commonly performed surgeries involving the facial nerve. A systematic review was conducted from articles published between September 2006 and December 2022. Suitable articles were identified from the MEDLINE/PubMed databases using relevant terms to meet the inclusion criteria. Articles were subsequently coded based on the inclusion/exclusion criteria as well as the type of surgery performed with concurrent use of EMG and the results from intraoperative monitoring. A total of 47 articles were found in relation to the use of IFNM, including studies to reduce the incidence and determine preventative measures to decrease nerve injury. Eleven articles were used to evaluate the use of EMG during various head and neck surgeries in decreasing the incidence of intraoperative facial nerve injury. Sources found were primarily divided based on the type of surgery performed when determining the use of EMG. Four sources tested the efficacy of EMG during parotidectomy, four sources during vestibular schwannoma resection, two sources during cochlear implant surgeries, and one during a lymphatic malformation surgery. IFNM also decreased the duration of surgery, the severity of facial nerve palsy, and the average time of facial nerve paralysis recovery. IFNM was found to not significantly predict facial nerve injury in the setting of intraoperative nerve injury but tended to preserve potential facial nerve function in vestibular schwannoma cases. The surgical setting determined the efficacy and use of IFNM in decreasing the incidence of facial nerve weakness and paralysis. IFNM had the best preventative and prognostic value when used in vestibular schwannoma resection, and the least in cochlear implants, with mixed evidence seen in the setting of parotidectomy. Overall, IFNM using EMG as an adjunct during surgery may reduce the risk of iatrogenic injury; however, additional studies must be performed to determine the degree of long-term patient satisfaction and quality of life achieved in the setting of IFNM.
PubMed: 38060739
DOI: 10.7759/cureus.48367 -
Otology & Neurotology : Official... Mar 2023Comprehensively analyze tumor control and treatment complications for jugular paraganglioma patients undergoing surgery versus stereotactic radiosurgery (SRS). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Comprehensively analyze tumor control and treatment complications for jugular paraganglioma patients undergoing surgery versus stereotactic radiosurgery (SRS).
DATABASES REVIEWED
EMBASE, Medline, and Scopus.
METHODS
The databases were searched for English and Spanish articles from January 1, 1995, to January, 1, 2019, for studies reporting tumor control and treatment side effects regarding patients with jugular paraganglioma treated with surgery or SRS. Main outcome measures included short-term and long-term tumor recurrence, as well as postintervention complications.
RESULTS
We identified 10,952 original abstracts, 705 eligible studies, and 107 studies for final data extraction. There were 3,498 patients-2,215 surgical patients and 1,283 SRS patients. Bayesian meta-analysis was applied to the extracted data, with tau measurements for study heterogeneity. SRS tumors were larger (3.9 cm 3 versus 8.1 cm 3 ). Meta-analysis results demonstrated low rates of long-term recurrence for both modalities (surgery, 15%; SRS, 7%), with SRS demonstrating lower rates of postintervention cerebrospinal fluid leak, dysphagia, and cranial nerve Vll, lX, X, Xl, or Xll palsies.
CONCLUSIONS
This study demonstrates excellent control of jugular paragangiomas with both surgery and SRS, with higher rates of lower cranial neuropathies, dysphagia, and cerebrospinal fluid leaks among surgical patients.
Topics: Humans; Radiosurgery; Bayes Theorem; Deglutition Disorders; Neoplasm Recurrence, Local; Glomus Jugulare Tumor; Treatment Outcome; Retrospective Studies
PubMed: 36728610
DOI: 10.1097/MAO.0000000000003781 -
European Archives of... Jan 2014The number of non-neurofibromatosis type 2 (NF2) indications for auditory brainstem implant (ABI) in the literature is increasing. The objective of this study was to... (Review)
Review
The number of non-neurofibromatosis type 2 (NF2) indications for auditory brainstem implant (ABI) in the literature is increasing. The objective of this study was to analyze and discuss the indications for ABI. Retrospective chart review and systematic review were conducted at Quaternary referral skull base center and referring centers. Analysis of ABI cases with non-NF2 indications and systematic review presenting non-NF2 ABI cases were performed. Fourteen referred cases with ABI were identified. All cases had unsatisfactory results of ABI and all could have been rehabilitated with a cochlear implant (CI). Of these 14 cases, 9 improved with a cochlear implant, and 2 with a hearing aid, two are still planned for CI, one received bilateral CI, no ABI. In literature, we found 31 articles presenting 144 non-NF2 ABI cases with at least 7 different indications other than NF2. ABI should be restricted to those patients who have no other rehabilitation options. Patency of the cochlea and evidence of an intact cochlear nerve should be examined with imaging and electrophysiologic testing. Sometimes a CI trial should be planned prior to proceeding with ABI. We have shown that in many cases a CI is still possible and CI provided better results than ABI. In vestibular schwannoma in the only hearing ear, cochlear otosclerosis, temporal bone fractures, (presumed) bilateral traumatic cochlear nerve disruption, auto-immune inner ear disease and auditory neuropathy primarily CI are indicated. Traumatic bilateral cochlear nerve disruption is exceptionally unlikely. In cochlear nerve aplasia, testing should be performed prior to meeting indications for ABI. In malformations, ABI is indicated only in severe cochlear hypoplasia or cochlear aplasia.
Topics: Auditory Brain Stem Implants; Cochlear Implants; Contraindications; Deafness; Hearing Loss; Hearing Loss, Central; Humans; Neuroma, Acoustic; Ossification, Heterotopic; Otosclerosis; Treatment Outcome; Vestibulocochlear Nerve Diseases
PubMed: 23404468
DOI: 10.1007/s00405-013-2378-3 -
Acta Neurochirurgica Dec 2022Surgery and radiosurgery represent the most common treatment options for vestibular schwannoma. A systematic review and meta-analysis were conducted to compare the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Surgery and radiosurgery represent the most common treatment options for vestibular schwannoma. A systematic review and meta-analysis were conducted to compare the outcomes of surgery versus stereotactic radiosurgery (SRS).
METHODS
The Cochrane library, PubMed, Embase, and clinicaltrials.gov were searched through 01/2021 to find all studies on surgical and stereotactic procedures performed to treat vestibular schwannoma. Using a random-effects model, pooled odds ratios (OR) and their 95% confidence intervals (CI) comparing post- to pre-intervention were derived for pre-post studies, and pooled incidence of adverse events post-intervention were calculated for case series and stratified by intervention type.
RESULTS
Twenty-one studies (18 pre-post design; three case series) with 987 patients were included in the final analysis. Comparing post- to pre-intervention, both surgery (OR: 3.52, 95%CI 2.13, 5.81) and SRS (OR: 3.30, 95%CI 1.39, 7.80) resulted in greater odds of hearing loss, lower odds of dizziness (surgery OR: 0.10; 95%CI 0.02, 0.47 vs. SRS OR: 0.22; 95%CI 0.05, 0.99), and tinnitus (surgery OR: 0.23; 95%CI 0.00, 37.9; two studies vs. SRS OR: 0.11; 95%CI 0.01, 1.07; one study). Pooled incidence of facial symmetry loss was larger post-surgery (14.3%, 95%CI 6.8%, 22.7%) than post-SRS (7%, 95%CI 1%, 36%). Tumor control was larger in the surgery (94%, 95%CI 83%, 98%) than the SRS group (80%, 95%CI 31%, 97%) for small-to-medium size tumors.
CONCLUSION
Both surgery and SRS resulted in similar odds of hearing loss and similar improvements in dizziness and tinnitus among patients with vestibular schwannoma; however, facial symmetry loss appeared higher post-surgery.
Topics: Humans; Neuroma, Acoustic; Radiosurgery; Microsurgery; Facial Nerve; Tinnitus; Dizziness; Treatment Outcome; Hearing Loss; Vertigo; Retrospective Studies
PubMed: 35962847
DOI: 10.1007/s00701-022-05338-z