The evaluation of vestibular compensation by vestibular rehabilitation and prehabilitation in short-term postsurgical period in patients following surgical treatment of vestibular schwannoma

Hrubá, Silvie; Chovanec, Martin; Čada, Zdeněk; Balatková, Zuzana; Fík, Zdeněk; Slabý, Kryštof; Zvĕrina, E; Betka, Jan; Plzák, Jan; Čakrt, Ondřej

doi:10.1007/s00405-019-05503-8

Cited by 13 publications

(25 citation statements)

References 19 publications

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“…Further, the length of hospital stay (day of surgery to day of discharge) was not decreased by vestibular prehab. Confidence Scale [10]. These latter results are well in line with our findings.…”

Section: Discussionsupporting

confidence: 93%

“…This may have led to the similar length of hospital stay. Lastly, the effects of vestibular prehab may also be masked by an intense vestibular rehabilitation in both groups [8,10]. We may add that vestibular rehabilitation exercises are thought to be the most important factor in compensating a vestibular loss, regardless of the etiology of the loss [7].…”

Section: Discussionmentioning

confidence: 97%

“…Several favorable outcomes after vestibular prehab have been reported, such as absence of dizziness and vertigo as well as a benefit in the postural control system in terms of a better short-(adaptation) and long-term (habituation) recovery [17,[25][26][27]. However, these positive results have all been reported by the same research group and have been challenged by two recent studies showing that vestibular prehab does neither improve objective outcomes, e.g., the subjective visual vertical or posturographic results, nor subjective outcomes such as quality of life from the view of postural control or the Activities-Specific Balance Confidence Scale [4,10].…”

Section: Introductionmentioning

confidence: 99%

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Postural stability and handicap of dizziness after preoperative vestibular ablation and vestibular prehabilitation in patients undergoing vestibular schwannoma resection

Fellmann

Bächinger

Dalbert

et al. 2022

VES

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BACKGROUND: Surgical treatment of vestibular schwannoma (VS) leads to acute ipsilateral vestibular loss if there is residual vestibular function before surgery. To overcome the sequelae of acute ipsilateral vestibular loss and to decrease postoperative recovery time, the concept of preemptive vestibular ablation with gentamicin and vestibular prehabilitation before surgery has been developed (“vestibular prehab”). OBJECTIVE: Studying postural stability during walking and handicap of dizziness over a 1-year follow-up period in VS patients undergoing vestibular prehab before surgical treatment of VS. METHODS: A retrospective review of consecutive patients with a diagnosis of a VS undergoing surgical therapy from June 2012 to March 2018 was performed. All patients were included with documentation of the length of hospital duration and the Dizziness Handicap Inventory (DHI) and the Functional Gait Assessment (FGA) assessed preoperatively as well as 6 weeks and 1 year postoperatively. RESULTS: A total 68 VS patients were included, of which 29 patients received preoperative vestibular ablation by intratympanic injection of gentamicin. Mean VS diameter was 20.2 mm (SD 9.4 mm) and mean age at surgery was 49.6 years (SD 11.5 years). Vestibular prehab had no effect on DHI and FGA at any time point studied. CONCLUSIONS: We found no effect of vestibular prehab on postural stability during walking and on the handicap of dizziness. These findings add to the body of knowledge consisting of conflicting results of vestibular prehab. Therefore, vestibular prehab should be applied only in selected cases in an experimental setting.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Postural stability and handicap of dizziness after preoperative vestibular ablation and vestibular prehabilitation in patients undergoing vestibular schwannoma resection

Fellmann

Bächinger

Dalbert

et al. 2022

VES

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“…Vestibular schwannoma (VS) is a slow-growing benign tumour arising from the Schwann Cells of the superior (SVN) or inferior (IVN) branch of the vestibulocochlear nerve [ 1 ], and the latter accounts for more than 90% of cases [ 2 ]. It is by far the most common tumour of the Cerebello–Pontine Angle (CPA) and represents 8–10% of all intracranial neoplasms [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Vestibular Impairment in Patients with Vestibular Schwannoma: A Journey through the Pitfalls of Current Literature

et al. 2023

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Vestibular Schwannoma is the most common tumour of Ponto Cerebellar Angle and is capable of strongly impacting the patient’s quality of life. In recent decades, the proposals for the management of the disease have multiplied, just as the diagnostic capacity has improved. While in the past, the primary objective was the preservation of the facial function, and subsequently also of the auditory function, the attention to the vestibular symptomatology, which appears to be one of the main indicators of deterioration of quality of life, is still unsatisfactory. Many authors have tried to provide guidance on the best possible management strategy, but a universally recognized guideline is still lacking. This article offers an overview of the disease and the proposals which have advanced in the last twenty years, evaluating their qualities and defects in a critical reading.

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“…However, the long-term benefits of prehabilitation are still unclear. Moreover, both vestibular rehabilitation and prehabilitation strategies mainly address the functional and physical aspects of vestibular function loss and may fail to address its emotional impact ( 28 , 29 ). Because this latter aspect seems to have the strongest correlation with a decrease in QoL and seems to play a role in a considerable proportion of vestibular schwannoma patients (34%), vestibular exercises only may not be the optimal strategy.…”

Section: Discussionmentioning

confidence: 99%

Vestibular Complaints Impact on the Long-Term Quality of Life of Vestibular Schwannoma Patients

Fuentealba-Bassaletti

Neve

Esch

et al. 2022

Otol Neurotol

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ObjectiveTo analyze the effect of dizziness-related symptoms on the long-term quality of life (QoL) of patients with unilateral vestibular schwannoma.MethodsIn this cross-sectional study, patients with a unilateral vestibular schwannoma diagnosed between 2004 and 2013 completed a disease-specific QoL questionnaire (Penn Acoustic Neuroma Quality of Life [PANQOL]) and the Dizziness Handicap Inventory (DHI) in 2020. Linear regression was performed to assess the correlation between QoL and the DHI total score, and the scores of the DHI functional, emotional, and physical subdomains. Potential confounders such as age, sex, tumor size at baseline, and treatment modality (active surveillance, surgery, or radiotherapy) were included in the model.ResultsIn total, 287 of 479 patients (59%) experienced dizziness with a median follow-up of 10 years. The DHI total score was significantly associated with the PANQOL total score. On average, we found a reduction of 0.7 points on the PANQOL for each additional point on the DHI. The DHI emotional subdomain was the most prominent determinant of poorer QoL. Each point on the DHI emotional subscale was associated with a reduction of 1.3 on the PANQOL score. Treatment modality did not have a clinically relevant effect on dizziness-related QoL.ConclusionsEven mild dizziness can have a significant and clinically relevant effect on the QoL of patients with unilateral vestibular schwannoma in the long term. This holds true for all treatment modalities. Addressing the vestibular problems may improve QoL in vestibular schwannoma patients, and DHI subscale analysis may help tailor the optimal vestibular intervention.

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The evaluation of vestibular compensation by vestibular rehabilitation and prehabilitation in short-term postsurgical period in patients following surgical treatment of vestibular schwannoma

Cited by 13 publications

References 19 publications

Postural stability and handicap of dizziness after preoperative vestibular ablation and vestibular prehabilitation in patients undergoing vestibular schwannoma resection

Postural stability and handicap of dizziness after preoperative vestibular ablation and vestibular prehabilitation in patients undergoing vestibular schwannoma resection

Vestibular Impairment in Patients with Vestibular Schwannoma: A Journey through the Pitfalls of Current Literature

Vestibular Complaints Impact on the Long-Term Quality of Life of Vestibular Schwannoma Patients

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