Hearing Grade Research Articles

Discriminant Analysis of the Prognostic Factors for Hearing Outcomes in Patients with Idiopathic Sudden Sensorineural Hearing Loss.

This study aims to determine and assess prognostic variables that might affect the hearing result in patients with idiopathic sudden sensorineural hearing loss following intratympanic steroid injection. In total, 190 patients with idiopathic sudden sensorineural hearing loss received intratympanic steroid injection. Two hearing indices (recovery and nonrecovery) will be analyzed as dependent variables; patient's age, time period between the onset of hearing loss and treatment, initial level of hearing (hearing loss pre), type of audiogram curve (upsloping, downsloping, and flat), presence of vertigo, presence of tinnitus, and diabetes) will be analyzed as prognostic factor variables. Recovery was seen in 72% of the patients. Different preinjection audiogram curves and hearing grades had a significant effect on recovery, absence of vestibular symptoms and no diabetic history were noted to have a good prognosis. Delay in treatment by more than 30 days from the onset of hearing loss was associated with a worse prognosis. Idiopathic sudden sensorineural hearing loss associated with late treatment plan more than 1 month, presence of vertigo, diabetes, and profound prehearing loss were negative prognostic factors. Whereas age, gender, and presence of tinnitus did not affect prognosis. More stable response was obtained when intratympanic steroids were added within 1 month after diagnosis, and the patient presented with mild or moderate hearing loss grade, flat or downsloping pure tone audiometery curve, and absence of vertigo and nondiabetic with significantly good results.

Pretreatment hearing grades and hearing recovery outcomes after primary hyperbaric oxygen treatment in patients with idiopathic sudden sensorineural hearing loss.

Previous studies suggest the effectiveness of hyperbaric oxygen treatment (HBOT) in idiopathic sudden sensorineural hearing loss (ISSNHL) but it is mostly used as an adjuvant and salvage treatment. This study evaluated the effect of primary HBOT according to pretreatment hearing grades and hearing recovery outcomes using modified Siegel's criteria in patients with ISSNHL. Fifty-nine ISSNHL patients treated with only HBOT were included. A pure-tone audiogram was recorded before and after a course of HBOT (90 min at 203 kPa daily for 20 days). Using the modified Siegel's criteria, patients were divided into groups according to hearing threshold before and after treatment. Hearing thresholds were significantly lower after HBOT compared to pre-treatment values across all patients (P < 0.001) with a median value of recovery of 22.5 dB (interquartile range 12.5-33.7 dB). Significantly lower hearing threshold values were recorded at 500, 1,000, 2,000, and 4,000 Hz after treatment (P < 0.001). The greatest recovery was at 1,000 Hz, (change in median threshold = 32 dB) but without a significant difference compared to other frequencies (P = 0.10). HBOT is a legitimate choice as the primary treatment for ISSNHL, especially if it is readily accessible, and if there are contraindications for corticosteroid therapy.

Hearing Preservation Surgery in the Sitting Position for Grade 3B Hannover Classification Vestibular Schwannoma: 3-Dimensional Operative Video.

Surgical treatment of large vestibular schwannomas is challenging. Both facial and cochlear nerves should be preserved in patients who have no neurological deficit preoperatively. In this 3-dimensional video, we present a 35-yr-old patient who presented with documented increase in the size of a known vestibular schwannoma over the span of 3 yr. Surgery was favored among all treatment options due to his young age and the tumor size. Informed consent was obtained. Semisitting surgery allowed for bimanual microdissection of the tumor capsule from the surrounding arachnoid and cranial nerves with 2 micro dissectors. The precision of microdissection is enhanced in the sitting position. Facial nerve stimulation remained stable at 0.05 mA. The auditory evoked potential remained unchanged during the surgery. Complete resection of the tumor and preservation of facial and cochlear nerves was achieved. The patient had a stable hearing grade B and a normal facial nerve function at 3-mo follow-up.

Modification and verification of the Infant\u2013Toddler Meaningful Auditory Integration Scale: a psychometric analysis combining item response theory with classical test theory

BackgroundEarly prelingual auditory development (EPLAD) is a fundamental and important process in the speech and language development of infants and toddlers. The Infant–Toddler Meaningful Auditory Integration Scale (ITMAIS) is a widely used measurement tool for EPLAD, however it has not yet undergone a comprehensive psychometric analysis. The aim of this research was to modify and verify the psychometric properties of ITMAIS using a combination of Item Response Theory (IRT) and Classical Test Theory (CTT).MethodsStage 1—1730 children were retrospectively recruited to enable the application of an IRT model, specifically the graded response model, to modify the ITMAIS. Stage 2—another 450 infants and toddlers with normal hearing or permanent hearing loss before auditory intervention were recruited to verify the psychometric properties of the modified ITMAIS (ITMAIS-m) using the CTT method.ResultsUsing the metric of the graded response model, by removing item 2 from the ITMAIS, ITMAIS-m demonstrated discrimination parameters ranging from 3.947 to 5.431, difficulty parameters from − 1.146 to 1.150, item information distributed between 4.798 and 9.259 and a test information score of 48.061. None of the items showed differential item functioning. ITMAIS-m was further verified in Stage 2, showing Cronbach’s α of 0.919 and item-total correlations ranging from 0.693 to 0.851. There was good convergent validity of ITMAIS-m with other auditory outcome measure (r = 0.932) and pure tone average thresholds (r ranging from − 0.670 to − 0.909), as well as a high ability to discriminate between different hearing grades (Cohen d ranging from 0.41 to 5.83).ConclusionsThe ITMAIS-m is a reliable and valid tool for evaluating EPLAD in infants and toddlers, which can be efficiently and precisely applied in clinical practice. The combined use of IRT and CTT provides a powerful means to modify psychometrically robust scales aimed at childhood auditory outcome measurements.

Physician decision support system for idiopathic sudden sensorineural hearing loss patients.

Idiopathic sudden sensorineural hearing loss (ISSNHL) is an emergency disease, and its pathogenesis is still largely unknown, making it difficult to diagnose and develop a therapeutic strategy. To predict the treatment outcomes and further customize the treatment strategy, we used a physician decision support system that incorporates complex information from electronic health records. We first developed the infrastructure of the physician decision support system, including an integrated data warehouse and an automatic data de-identification workflow. We next conducted a cohort study to evaluate the treatment outcomes of 757 ISSNHL patients using the modified Siegel's criteria. The complete recovery (<25 dB) as a hearing outcome for ISSNHL patients was compared based on pretreatment hearing grades and disease onset with adjusted for age and sex after treatment initiation. The results showed that a complete recovery hearing outcome based on pretreatment hearing grades and disease onset in consideration of age and sex was associated with a low risk of pretreatment hearing Grade 2 (26-45 dB) (adjusted odds ratio 12.3, 95% confidence interval [CI]: 4.8-31.3) and disease onset ≤7 days (adjusted odds ratio 13.9, 95% CI: 4.2-45.8), respectively. Hearing recovery outcomes among complete recovery and noncomplete recovery (>25 dB) subjects according to pretreatment hearing grades were 32.9% (Grade 2 or 26-45 dB HL), 25.4% (Grade 3 or 46-75 dB HL), 31.1% (Grade 4 or 76-90 dB), and 4.5% (Grade 5, or >90 dB HL) (p < 0.0001). Patients with pretreatment hearing Grade 2 who received treatment within ≤7 days of disease onset had the highest rate of complete recovery (32.9%, 23/70). In summary, using the physician decision support system, we successfully identified two predictors, the pretreatment hearing Grade 2 (26-45 dB) and treatment within ≤7 days of disease onset, associated with the highest odds of achieving complete recovery (<25 dB) of hearing in patients with ISSNHL.

Association Between Hearing Loss and Postural Instability in Older Korean Adults

Hearing loss is one of the most frequently occurring sensory disabilities worldwide. The association between hearing loss and postural instability in an older population remains to be studied. To determine whether the odds of postural instability increase with the degree of hearing loss and to suggest criteria for hearing rehabilitation for postural instability. This cross-sectional population-based study of 3864 participants 40 years and older with hearing loss used data from 2010 through 2012 in the fifth edition of the Korea National Health and Nutrition Examination Survey, a nationwide survey of South Korea. Pure tone audiometry was performed on both the left and right sides and each hearing grade of each side was classified into 1 of 3 subcategories: normal hearing, mild hearing loss, or moderate hearing loss (moderate hearing loss or worse). Postural instability was defined as the failure to remain standing on a foam pad surface with feet 10 cm apart with arms folded and hands cupping the elbows and eyes closed. A binomial logistic regression model was used to assess the association between hearing loss and postural instability. Data were analyzed from August 18, 2019, to September 2, 2019. Age-related hearing loss defined as a threshold of 26 dB or more. The degree of hearing loss and postural instability. Of the 3864 participants included in the study, the mean (SD) age was 57.8 (11.3) years and 2135 (55.2%) were women. Female sex was associated with higher odds of postural instability compared with male sex (odds ratio [OR], 1.65; 95% CI, 1.12-2.42, adjusted for age and hearing status), and the odds of postural instability increased with every 1 year increase in age (OR, 1.13; 95% CI, 1.10-1.16, adjusted for sex and hearing status). Unilateral or bilateral mild hearing loss was not associated with an increase in the odds of postural instability, but moderate hearing loss present on at least 1 side was associated with an increase in the odds of postural instability: unilateral moderate hearing loss group (OR, 2.71; 95% CI, 1.12-6.10, adjusted for age and sex), one mild and the other moderate hearing loss group (OR, 2.18; 95% CI, 1.16-4.09, adjusted for age and sex), and bilateral moderate hearing loss group (OR, 2.34; 95% CI, 1.27-4.33, adjusted for age and sex). Aging, female sex, and having hearing loss were associated with postural instability in this analysis. Moderate or worse hearing loss present on at least 1 side was associated with increased odds of postural instability. Future research in this area is warranted to identify more precise interrelationships and preventive measures.

Postoperative Hearing Preservation in Patients Undergoing Retrosigmoid Craniotomy for Resection of Vestibular Schwannomas: A Systematic Review of 2034 Patients.

Vestibular schwannomas (VS) are benign tumors derived from Schwann cells ensheathing the vestibulocochlear nerve. The retrosigmoid (RS) surgical approach is useful to resect tumors of multiple sizes while affording the possibility of preserving postoperative hearing. To conduct a systematic review of published literature investigating hearing preservation rates in patients who underwent the RS approach for VS treatment. The PubMed, Scopus, and Embase databases were surveyed for studies that reported preoperative and postoperative hearing grades on VS patients who underwent RS treatment. Hearing preservation rates were calculated, and additional patient demographic data were extracted. Tumor size data were stratified to compare hearing preservation rates after surgery for intracanalicular, small (0-20 mm), and large (>20 mm) tumors. Of 383 deduplicated articles, 26 studies (6.8%) met eligibility criteria for a total of 2034 patients with serviceable preoperative hearing, for whom postoperative hearing status was evaluated. Aggregate hearing preservation was 31% and 35% under a fixed and random effects model, respectively. A mixed effects model was used to determine hearing preservation rates depending on tumor size, which were determined to be 57%, 37%, and 12% for intracanalicular, small, and large tumors, respectively. Significant cross-study heterogeneity was found (I2=93%, τ2=.964, P<.01; Q=287.80, P=<.001), with rates of hearing preservation ranging from 0% to 100%. Tumor size may have an effect on hearing preservation rates, but multiple factors should be considered. Discussion of a patient's expectations for hearing preservation is critical when deciding on VS treatment plans.

Hearing preservation after Gamma Knife radiosurgery for cerebellopontine angle meningiomas

OBJECTIVEThe objective of this study was to assess hearing function after Gamma Knife treatment of cerebellopontine angle (CPA) meningiomas and assess factors affecting hearing outcome. Additionally, the authors opted to compare these results with those after Gamma Knife treatment of vestibular schwannomas (VSs), because most of the information on hearing outcome after stereotactic radiosurgery (SRS) comes from reports on VS treatment. Hearing preservation, to the best of the authors' knowledge, has never been separately addressed in studies involving Gamma Knife radiosurgery (GKRS) for CPA meningiomas.METHODSThis study included all patients who underwent a single session of GKRS between 2002 and 2014. The patients were divided into two groups. Group A included 66 patients with CPA meningiomas with serviceable hearing and tumor extension into the region centered on the internal auditory meatus. Group B included 144 patients with VSs with serviceable hearing. All patients had serviceable hearing before treatment (Gardner-Robertson [GR] Grades I and II). The median prescription dose was 12 Gy (range 10-12 Gy) in both groups. The median follow-up of groups A and B was 42 months (range 6-149 months) and 49 months (range 6-149 months), respectively.RESULTSAt the last follow-up, the tumor control rate was 97% and 94% in groups A and B, respectively. Hearing preservation was defined as maintained serviceable hearing according to GR hearing score. The hearing preservation rate was 98% and 66% and the 7-year actuarial serviceable hearing preservation rate was 75% and 56%, respectively, between both groups. In group A, the median maximum cochlear dose in the patients with stable and worsened hearing grade was 6.3 Gy and 5.5 Gy, respectively. In group B, factors affecting hearing preservation were cochlear dose ≤ 7 Gy, follow-up duration, and tumor control. The only determinant of hearing preservation between both groups was tumor type.CONCLUSIONSGKRS for CPA meningiomas provides excellent hearing preservation in addition to high tumor control rate. Hearing outcome is better with CPA meningiomas than with VSs. Further long-term prospective studies on determinants of hearing outcome after GKRS for CPA meningiomas should be conducted.

HOUT-13. POSTOPERATIVE HEARING PRESERVATION IN PATIENTS UNDERGOING RETROSIGMOID CRANIOTOMY FOR RESECTION OF VESTIBULAR SCHWANNOMAS: A META-ANALYSIS OF 1,249 PATIENTS

Author(s): Ong, Vera; Kwan, Isabelle | Advisor(s): Yang, Isaac | Abstract: Objective To investigate the estimated hearing preservation rates in patients with sporadic VS (vestibular schwannomas) after RS (retrosigmoid) surgery through a meta-analysis based on the published hearing outcomes within the current literature.Data Sources Both the PubMed and Cochrane databases were used to identify retrospective and prospective studies which involved hearing outcomes of VS patients who underwent the RS approach. The final search was performed on November 11, 2017. The first and third authors independently reviewed the aggregated articles, and final decisions of study inclusion were dependent on consensus.Study Selection Of 313 articles, 16 studies (5.1%) met eligibility criteria. Together, these 16 studies comprised a total of 1,249 patients with serviceable preoperative hearing in the affected ear, from whom postoperative hearing preservation could be evaluated.Data Extraction Both preoperative and postoperative hearing grades were extracted to determine the hearing preservation rate presented in the group of patients in each article. Additionally, demographics regarding gender, age, mean tumor size, and mean FU (follow-up) time pertaining to the patients in each article were extracted as well.Data Synthesis Study heterogeneity was quantified through computation of t2,Q, and I2 statistics. A Wald-type Q statistic was used to assess statistical significance of study heterogeneity. Assessment of study bias was performed using standard funnel plot analysis and an Egger’s test for funnel plot asymmetry. Significant cross-study heterogeneity was found, with rates of hearing preservation ranging from 12-79% across studies. Aggregate hearing preservation was 23% under a fixed effects model and 37% allowing for random study effects. Clear systematic bias was also apparent, with disproportionate numbers of (mostly smaller) studies reporting hearing preservation rates markedly higher than the aggregate estimates (Pl 0.0001). As expected, rates of hearing preservation were also strongly dependent on preoperative tumor size, with rates of 59%, 37%, and 11% observed for intracanalicular, small, and large (g20 mm) tumors, respectively.Conclusions Hearing preservation rates are likely dependent on multiple factors and tumor size has a strong effect. It is critical to discuss the patient’s expectations for hearing preservation when deciding on treatment plans for VS.

Modified Siegel's criteria for sudden sensorineural hearing loss: Reporting recovery outcomes with matched pretreatment hearing grades

BackgroundSudden sensorineural hearing loss (SSNHL) is an emergency clinical otology condition defined as hearing loss greater than 30 dB over three consecutive frequencies within 72 h. We aimed to integrate pretreatment hearing grades with reports of treatment recovery outcomes of SSNHL using the modified Siegel's criteria. MethodsThis was a retrospective cohort study comprising 110 patients with SSNHL seen between January 2014 and January 2015. The patients were treated with combined systemic and intra-tympanic steroid therapy. The audiometric results were recorded using the modified Siegel's criteria, including pretreatment hearing grades 1–5 (grade 1: hearing threshold under 25 dB, grade 2: hearing threshold 26–45 dB, grade 3: hearing threshold 46–70 dB, grade 4: hearing threshold 71–90 dB, grade 5: hearing threshold over 90 dB) and hearing recovery outcomes, consisting of complete recovery (CR), partial recovery (PR), slight improvement (SI), no improvement (NI) or non-serviceable ears (NS). Patients were further assessed based on the treatment modality (initial or salvage treatment) and duration of the treatment delay. ResultsHearing improvements (CR + PR + SI) were seen in 56 patients. Patients with pretreatment hearing grade 3 had the highest improvement rate (88.2% or 30/34). Patients who received the combined steroid therapy as the initial modality had a better overall hearing improvement rate than did the salvage group. Treatment within the first 14 days yielded a better hearing improvement rate than did late treatments of more than 14 days, especially in patients with a pretreatment hearing grade of 5. ConclusionUsing the modified Siegel's criteria, we report the hearing recovery outcomes with matched pretreatment hearing grades of patients with SSNHL treated with combined intra-tympanic steroid therapy. Our results show the prognostic significance of pretreatment hearing grades in patients with SSNHL.

The use of uHear™ to screen for hearing loss in older patients with cancer as part of a comprehensive geriatric assessment

Objective: We previously validated uHear™ to screen for hearing loss in older patients with cancer without a known hearing loss, as part of a comprehensive geriatric assessment (CGA). In view of low specificity, we tested a new modified uHear™ scoring system as described by Handzel.Methods: Patients, aged ≥70 years, were evaluated by uHear™ and conventional audiometry, which is considered the gold standard, as part of a CGA. The pass or fail screening cut-off for uHear™ was defined as having ≥2 consecutive hearing grades starting from the moderate–severe threshold zone ranging from 0.5 to 2.0 kHz (modified Handzel-uHear™ scoring system). To accept the modified Handzel-uHear™ as screening tool, it was predefined that the combined sensitivity (S) and specificity (Sp) of the test (S + Sp/2) was at least 80% and that an actual combined (S + Sp)/2 of 90% would be found.Results: Ninety ears (45 subjects) were tested. Of those ears, 24.4% were identified as impaired by conventional audiometry. Modified Handzel-uHear™ identified 26.7% of tested ears as impaired. The combined (S + Sp)/2 of the modified Handzel-uHear™ was calculated as 77.5%, while in previous cohort, this was retrospectively calculated as 94.6%. A new uHear™ scoring system was proposed and tested in current and previous cohort. A (S + Sp)/2 of 80.2 and 78.8%, respectively, were obtained.Conclusion: uHear™ is a feasible tool for use within the CGA and shows promising results. However, further research is warranted to optimize the cut-off method before it could be routinely implemented within geriatric oncology.

Genetic Severity Score predicts clinical phenotype in NF2

​BackgroundThe clinical severity of disease in neurofibromatosis type 2 (NF2) is variable. Patients affected with a constitutional truncating NF2 mutation have severe disease, while missense mutations or mosaic mutations present...

Stereotactic radiosurgery for facial nerve schwannomas: A preliminary assessment and review of the literature

Objective. Facial nerve schwannomas (FNS) are rare tumors, and their appropriate management remains the subject of considerable debate. This report details the results of a series of patients with FNS treated with stereotactic radiosurgery (SRS) at the University of Virginia. Methods. We performed a retrospective review of the clinical and imaging outcomes of 5 patients who underwent Gamma Knife RS (GKRS) for small-to-medium-sized (< 5 mL) FNS at our institution. The study population consisted of 3 males and 2 females with a median age of 35 years. All patients presented with varying degrees of facial palsy and/or hearing dysfunction. Tumor volumes at GKRS ranged from 0.1 to 5 (median = 0.8) mL. The median maximum radiosurgical dose and tumor margin dose were 24 Gy and 12 Gy, respectively. Results. After a median follow-up period of 12 (range, 6–36) months, three tumors were radiographically smaller and two remained stable. Facial function improved in three patients, remained stable in one patient, and slightly declined from House–Brackmann grade I to II in one patient. Hearing function was preserved in three patients and deteriorated in two patients, one from Gardner–Robertson grade I to II and the other from serviceable hearing grade II to III. Conclusion. SRS appears to offer a reasonable rate of facial nerve preservation and tumor control for patients with small-to-medium-sized FNS. Considering the published outcomes achieved with resection, RS may be the preferred first-line treatment for these tumors.

P13.01 * GAMMA KNIFE RADIOSURGERY FOR THE MANAGEMENT OF VESTIBULAR SHWANNOMAS IN NEUROFIBROMATOSIS TYPE 2 PATIENTS: TUMOR CONTROL AND HEARING PRESERVATION

OBJECTIVE: Gamma knife radiosurgery GKS for the treatment of the patients with Neurofibromatosis type 2 (NFII) is used for many years to achieve better tumor control, and to avoid postoperative neurological deficits. This study aimed at exploring the effect of GKS on the control rate, factors affecting such control, neurological morbidity, and the hearing preservation with such management. METHODS: Between February 2002 and October 2012, seventy-nine patients with vestibular schwannomas associated with NF II were treated by gamma knife radiosurgery at our centre. Fifty-seven patients harbouring 91 tumours were available for follow up for a minimum of 12 months after treatment. The follow up duration ranged from 12 to 126 months (mean 47.8 months). We treated 31 females (54 %) and 26 males (46 %) with a mean age of 26.8 years (range 9-56 years). Twenty one lesions (23.1%) were correlated to a family history of NFII. Seventy-two lesions were bilateral (79.1%). Thirty-six lesions (39.6 %) had previous surgeries, and only three lesions (3.3%) received previous radiotherapy. Before treatment, 45 lesions (49.5%) were associated with serviceable hearing. The mean target volume was 5.26 cc (range 0.1 to 27.5 cc). The mean marginal dose was 11.93 Gy (range 8 to 13 Gy), with a mean isodose of 52.57% (range 40-95%), and mean percent coverage was 94.23% (range 77-100%). RESULTS: Regarding the overall radiological response, 24 lesions (26.4%) had regressed, 57 (62.6%) remained stable, and 10 (11%) had progressed with 89% tumor control. Progression free survival at 3, 5, and 10 years were (99, 91.8, and 42.9 %). Univariate analysis showed that better tumor control correlates with older age, smaller lesion size, and follow up duration. While, preserved hearing correlates with younger age, smaller lesions, hearing grade, and no previous surgery or radiotherapy. The multivariate analysis showed that the tumor control was affected by bilaterality, family history, and selectivity index. Regarding the hearing outcome, it was affected by age and bilaterality. Edema developed in only 4 lesions (4.4%). Three patients complained of facial palsy which was temporary and resolved after medical treatment in less than a year. Using a median dose of 12 Gy maintained serviceable hearing in 27 lesions with a 60% hearing preservation rate. CONCLUSION: Gamma knife radiosurgery for NFII patients is a safe and effective treatment modality that can achieve excellent tumor control with preserved hearing and low risk of neurological morbidity.

Smartphone-Based Hearing Test as an Aid in the Initial Evaluation of Unilateral Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss (SSNHL) can cause significant morbidity. Treatment with steroids can improve outcome. Delay in initiation of treatment reduces the chance to regain hearing. For this reason SSNHL is considered an emergency. Diagnosis is based on history, physical examination and a standard audiogram, the latter requiring specialized equipment and personnel. Standard audiogram may not be available at the time and place of patient presentation. A smartphone or tablet computer-based hearing test may aid in the decision to prescribe steroids in this setting. In this study the uHear™ hearing test application was utilized. The output of this ear-level air conduction hearing test is reported in hearing grades for 6 frequencies ranging from 250 to 6000 Hz. A total of 32 patients with unilateral SSNHL proven by a standard audiogram were tested. The results of standard and iPod hearing tests were compared. Based on the accepted criterion of SSNHL (at least 30 dB loss - or 2 hearing grades - in 3 consecutive frequencies) the test had a sensitivity of 0.76 and specificity of 0.91. Using a less stringent criterion of a loss of 2 hearing grades over at least 2 frequencies the sensitivity was 0.96 and specificity 0.86. The correlation coefficient for the comparison of the average hearing grade across the 6 measured frequencies of the study and standard audiogram was 0.83. uHear more accurately reflected hearing thresholds at mid and high tones. Similarly to previously published data, low frequency thresholds could be artificially elevated. In conclusion, uHear can be useful in the initial evaluation of patients with single-sided SSNHL by providing important information guiding the decision to initiate treatment before a standard audiogram is available.

Statistical Model for Prediction of Hearing Loss in Patients Receiving Cisplatin Chemotherapy

This statistical model might be used to predict cisplatin-induced hearing loss, particularly in patients undergoing concomitant radiotherapy. To create a statistical model based on pretreatment hearing thresholds to provide an individual probability for hearing loss from cisplatin therapy and, secondarily, to investigate the use of hearing classification schemes as predictive tools for hearing loss. Retrospective case-control study. Tertiary care medical center. A total of 112 subjects receiving chemotherapy and audiometric evaluation were evaluated for the study. Of these subjects, 31 met inclusion criteria for analysis. The primary outcome measurement was a statistical model providing the probability of hearing loss following the use of cisplatin chemotherapy. Fifteen of the 31 subjects had significant hearing loss following cisplatin chemotherapy. American Academy of Otolaryngology-Head and Neck Society and Gardner-Robertson hearing classification schemes revealed little change in hearing grades between pretreatment and posttreatment evaluations for subjects with or without hearing loss. The Chang hearing classification scheme could effectively be used as a predictive tool in determining hearing loss with a sensitivity of 73.33%. Pretreatment hearing thresholds were used to generate a statistical model, based on quadratic approximation, to predict hearing loss (C statistic = 0.842, cross-validated = 0.835). The validity of the model improved when only subjects who received concurrent head and neck irradiation were included in the analysis (C statistic = 0.91). A calculated cutoff of 0.45 for predicted probability has a cross-validated sensitivity and specificity of 80%. Pretreatment hearing thresholds can be used as a predictive tool for cisplatin-induced hearing loss, particularly with concomitant radiotherapy.

Hearing evaluation of head and neck cancer patients (HNCP): Comparison of adverse event (AE) criteria.

5525 Background: The incidence and severity of baseline hearing abnormality in HNCP is poorly characterized, as is the subsequent CDDP associated hearing loss. While formal behavioral audiograms can characterize CDDP associated hearing loss in great detail, most oncologists either rely on subjective evaluation of hearing loss or grade hearing impairment using the CTCAE. Two new grading systems for grading cisplatin ototoxicity have been developed for use in pediatrics, the Brock and Chang systems. This report is the first evaluation of these 3 hearing loss criteria in an adult cancer patient population. Methods: We conducted an electronic medical records (EMR) search for all HNCP between 2004 and 2010 treated at the Stanford Cancer Institute (SCI) and identified which patients had audiograms in the EMR, and who had received CDDP. Three investigators (RL, ADC, KC) independently graded these audiograms using the CTCAE v3 and v4, Brock and Chang criteria. Baseline distributions, changes following CDDP dosing, and inter-observer variability were calculated for hearing impairment grading using all four criteria. Results: We evaluated 460 audiograms in 111 patients. Because 282/460 of the audiograms did not have threshold shifts measured at 1,2,3,4,6 and 8 kHz, CTCAE v4 could not be applied to them . We therefore limited all further comparisons to CTCv3, Brock and Chang criteria. The table below summarizes the analysis. Conclusions: The Brock and Chang ototoxity criteria scales deliver a distribution of hearing AE grades at baseline more compatible than the CTCAE v3 with respect to the expectation that most HNCP do not have severe baseline hearing loss. Both the Brock and Chang scales are more sensitive than the CTCv3 to CDDP associated hearing changes. The Brock scale, followed by the Chang scale, demonstrated highest inter-rater agreement. Additional data concerning performance characteristics and utility of these three grading systems will be presented. Replacement of the present hearing impairment criteria in the CTCAE with either the Brock or Chang scales should be considered. [Table: see text]

HEARING PRESERVATION AFTER INTRACANALICULAR VESTIBULAR SCHWANNOMA RADIOSURGERY

Tumor control, facial function preservation, and hearing preservation are important criteria for successful management of intracanalicular vestibular schwannomas, whether observation, microsurgery, or radiosurgery is chosen. We collected data prospectively to assess hearing preservation after intracanalicular vestibular schwannoma radiosurgery. Between 1987 and 2003, 96 patients (65 men and 31 women) underwent gamma knife stereotactic radiosurgery (SRS) for intracanalicular tumors. The median patient age was 54 years (range, 22-80 years). Hearing was graded using the Gardner-Robertson (GR) and the American Academy of Otolaryngology-Head and Neck Surgery classifications. Dose planning was performed on intraoperative stereotactic images using multiple 4-mm isocenters. The median tumor volume was 0.112 mm3 (range, 0.05-0.447 mm3), and the median margin dose was 13 Gy (range, 10-18 Gy). The mean and median audiologic follow-up periods were 42 months and 28 months (range, 12-144 months), respectively. Serviceable hearing was preserved in 31 of 40 (77.5%) patients with initial American Academy of Otolaryngology-Head and Neck Surgery Class A hearing. Serviceable hearing was preserved in 40 of 79 (64.5%) patients with GR Grade I or II pre-SRS hearing. Ninety-two patients had GR Grade I, II, or III hearing before SRS, and GR Grade I, II, or III hearing was maintained in 78 patients (85%). Hearing grades improved in 7 patients. Facial and trigeminal nerve function was preserved in all patients. The tumor control rate (freedom from additional intervention) was 99.0% (95 of 96) at a median follow-up of 28 months (range, 12-144 months). One patient underwent tumor resection 18 months after radiosurgery. SRS is a minimally invasive first-line management option for patients with intracanalicular tumors and provides high rates of hearing preservation with minimal morbidity.

Hearing preservation following fractionated stereotactic radiotherapy for vestibular schwannomas: prognostic implications of cochlear dose

The goal in this study was to evaluate hearing preservation rates and to determine prognostic factors for this outcome following fractionated stereotactic radiotherapy (FSRT) of vestibular schwannoma. Thirty-four consecutive patients with serviceable hearing who received FSRT between May 1998 and December 2003 were identified. Clinical and audiometry data were collected prospectively. The prescription dose was 45 Gy in 25 fractions prescribed to the 90% isodose line. The median follow-up duration was 36.5 months (range 12-85 months). The actuarial 2- and 4-year local control rates were 100 and 95.7%, respectively. Permanent trigeminal and facial nerve complications were 0 and 6%, respectively. The actuarial 2- and 3-year serviceable hearing preservation rates were both 63%. The median loss in speech reception threshold was 15 dB (range--10 to 65 dB). The radiotherapy dose to the cochlea was the only significant prognostic factor for hearing deterioration. Radiotherapy dose to the cochlear nucleus, patient age, sex, pre-FSRT hearing grade, tumor volume, and intracanalicular tumor volume failed to show any significance as prognostic factors. Five cases were replanned with four different radiotherapy techniques (namely arcs, dynamic arcs, static conformal fields, and intensity-modulated radiotherapy), with the cochlea defined as an organ at risk. In all cases, replanning resulted in statistically significant reduction in radiation to the cochlea (p = 0.001); however, no single replanning technique was found to be superior. The radiation dose to the cochlea is strongly predictive for subsequent hearing deterioration. It is essential for the cochlea to be outlined as an organ at risk, and for radiation techniques to be optimized, to improve long-term hearing preservation.

Clinical experience with gamma knife stereotactic radiosurgery in the management of vestibular schwannomas secondary to type 2 neurofibromatosis

Objective: To evaluate the results of stereotactic radiosurgery treating vestibular schwannomas secondary to type 2 neurofibromatosis. Methods: A retrospective review of 122 type 2 neurofibromatosis vestibular schwannomas consecutively treated in...