Incidence of high-frequency hearing loss after microvascular decompression for hemifacial spasm

Ying, Tiejin; Shah, Aalap; Nikonow, Tara; Wichman, Kelley; Holmes, Maura; Hirsch, Barry E.; Chang, Yue‐Fang; Gardner, Paul A.; Habeych, Miguel; Crammond, Donald J.; Burkhart, Lois; Horowitz, Michael; Balzer, Jeffrey

doi:10.3171/2013.1.jns121153

Cited by 20 publications

(22 citation statements)

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“…28 Analysis was performed at various stages during the surgery: 1) baseline, after intubation and positioning of the patient; 2) dura open, the epoch when the opening of the dura mater was documented; 3) change max, the maximum change in latency or amplitude recorded compared with average baseline waveform, including epochs when the responses were completely lost; and 4) on skin, the last epoch recorded.…”

Section: Analysis Of Neurophysiological Parametersmentioning

confidence: 99%

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Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Frederickson

Balzer

Crammond

et al. 2015

JNS

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M icrovascular decompression (MVD) is a safe and efficacious procedure for the treatment of hemifacial spasm (HFS), a debilitating condition that reduces patients' quality of life. Severe sensorineural hearing loss (SNHL) across all frequencies is a known complication of the operation, with reported rates ranging from 1.4% to 20%. 4,12,[18][19][20][21]24 In addition to severe SNHL, however, a recent report has raised concern that as many as one-half of patients undergoing MVD for HFS may experience high-frequency (4-8 kHz) hearing loss.28 Although this type of hearing loss is not as obviously apparent upon clinical follow-up as severe SNHL, high-frequency hearing loss (HFHL) can profoundly reduce the quality of life of patients. 5,10 Although the prior report implicated noise from the high-speed surgical drill as the cause of HFHL following MVD, we conducted this study to examine the incidence of HFHL, with an emphasis on retractorless MVD for treatment of HFS.abbreviatioNs BAEP = brainstem auditory evoked potential; HFHL = high-frequency hearing loss; HFS = hemifacial spasm; MVD = microvascular decompression; SNHL = sensorineural hearing loss; SPL = sound pressure level. obJect Microvascular decompression is a safe and effective procedure to treat hemifacial spasm, but the operation poses some risk to the patient's hearing. While severe sensorineural hearing loss across all frequencies occurs at a low rate in experienced hands, a recent study suggests that as many as one-half of patients who undergo this procedure may experience ipsilateral high-frequency hearing loss (HFHL), and as many as one-quarter may experience contralateral HFHL. While it has been suggested that drill-related noise may account for this finding, this study was designed to examine the effect of a number of techniques designed to protect the vestibulocochlear nerve from operative manipulation on the incidence of HFHL. methods Pure-tone audiometry was performed both preoperatively and postoperatively on 67 patients who underwent microvascular decompression for hemifacial spasm during the study period. A change of greater than 10 dB at either 4 kHz or 8 kHz was considered to be HFHL. Additionally, the authors analyzed intraoperative brainstem auditory evoked potentials from this patient cohort. results The incidence of ipsilateral HFHL in this cohort was 7.4%, while the incidence of contralateral HFHL was 4.5%. One patient (1.5%; also included in the HFHL group) experienced an ipsilateral nonserviceable hearing loss. coNclusioNs The reduced incidence of HFHL in this study suggests that technical modifications including performing the procedure without the use of fixed retraction may greatly reduce, but not eliminate, the occurrence of HFHL following microvascular decompression for hemifacial spasm.

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Section: Analysis Of Neurophysiological Parametersmentioning

confidence: 99%

“…Pure-tone audiometry was performed as described by Ying et al 28 Preoperative audiometry was performed between 1 and 142 days (mean 9.2 days, median 1 day). Postoperative audiometry was performed between 1 and 16 days (mean 2.1 days, median 1 day).…”

Section: Audiometrymentioning

confidence: 99%

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Frederickson

Balzer

Crammond

et al. 2015

JNS

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“…HFHL probably was not secondary to stretching of the auditory nerve during MVD but likely was induced by high-intensity drilling noise during craniotomy early in the procedure. 34 Studies performed on hair cells in animal models have reported evidence of reestablished signal transduction upon regeneration of the tip links of hair cells in cultured explants 6 hours after the stimulus, 35 or in vivo after 24-120 hours. 15 The time course of hair cell tip link regeneration suggests that this process may underlie recovery from temporary threshold shift induced by noise exposure.…”

Section: Discussionmentioning

confidence: 99%

“…The design of the study and the analysis of the data are intended to be similar to those used in a study published previously by many of the present paper's authors. 34 …”

Section: Methods Study Designmentioning

confidence: 99%

“…Patients with significant HFHL (> 10 dB change in pure tone audiometry) have deficiencies in high-frequency components of speech, such as consonant sounds, and can have difficulties understanding speech in the presence of background noise. 34 These deficiencies can have a negative impact on lifestyle because these patients may be unable to distinguish words that start and end with similar consonant sounds. Recognizing and understanding the incidence and pathogenesis of HFHL will be helpful in developing strategies to prevent it during MVD in particular and in craniotomies in general.…”

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The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia

Meigh

Dasyam²,

Shankar³

et al. 2015

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S enSorineural hearing loss after microvascular decompression (MVD) has a reported incidence of 1%-23.8% when performed for trigeminal neuralgia (TGN), 1.5%-4.2% for glossopharyngeal neuralgia (GPN), and 22% for geniculate neuralgia (GN). 21,24,25,27 Because of the proximity of the cranial nerve VIII to cranial nerves decompressed during the procedure, the auditory nerve in many patients is often stretched or damaged, resulting in hearing impairment. Although sensorineural hearing loss after MVD is frequently documented and well understood, high-frequency hearing loss (HFHL) is currently not well recognized. HFHL has been recently reported after MVD for hemifacial spasm (HFS). . disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect The primary aim of this study was to evaluate the incidence and discuss the pathogenesis of high-frequency hearing loss (HFHL) after microvascular decompression (MVD) for trigeminal neuralgia (TGN), glossopharyngeal neuralgia (GPN), or geniculate neuralgia (GN). methods The authors analyzed preoperative and postoperative audiogram data and brainstem auditory evoked potentials (BAEPs) from 93 patients with TGN, 6 patients with GPN, and 8 patients with GN who underwent MVD. Differences in pure tone audiometry > 10 dB at frequencies of 0.25, 0.5, 1, 2, 4, and 8 kHz were calculated preoperatively and postoperatively for both the ipsilateral and the contralateral sides. Intraoperative monitoring records were analyzed and compared with the incidence of HFHL, which was defined as a change in pure tone audiometry > 10 dB at frequencies of 4 and 8 kHz. results The incidence of HFHL was 30.84% on the side ipsilateral to the surgery and 20.56% on the contralateral side. Of the 47 patients with HFHL, 20 had conductive hearing loss, and 2 experienced nonserviceable hearing loss after the surgery. The incidences of HFHL on the ipsilateral side at 4 and 8 kHz were 17.76% and 25.23%, respectively, and 8.41% and 15.89%, respectively, on the contralateral side. As the audiometric frequency increased, the number of patients with hearing loss increased. No significant postoperative difference was found between patients with and without HFHL in intraoperative BAEP waveforms. Sex, age, and affected side were not associated with an increase in the incidence of hearing loss. coNclusioNs High-frequency hearing loss occurred after MVD for TGN, GPN, or GN, and the greatest incidence occurred on the ipsilateral side. This hearing loss may be a result of drill-induced noise and/or transient loss of cerebrospinal fluid during the course of the procedure. Changes in intraoperative BAEP waveforms were not useful in predicting HFHL after MVD. Repeated postoperative audiological examinations may be useful in assessing the prognosis of HFHL.

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Perioperative Adverse Events of Microvascular Decompression: Review and a Personal Experience of 2263 Cases

Kong

Park

2015

Microvascular Decompression Surgery

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Incidence of high-frequency hearing loss after microvascular decompression for hemifacial spasm

Cited by 20 publications

References 34 publications

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia

Perioperative Adverse Events of Microvascular Decompression: Review and a Personal Experience of 2263 Cases

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