Karen I. Berliner

New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma.

Standardization of reporting results of vestibular schwannoma (acoustic neuroma) surgery has been discussed ever since the first Acoustic Neuroma Conference in 1991 (Copenhagen). However, it has been difficult to reach consensus and to agree on a standardized system because these conferences are held only once every 4 years. In view of this, the Consensus Meeting on Systems for Reporting Results in Acoustic Neuroma (chairman, Dr. Kanzaki) was convened, and 40 neurotologists, neurosurgeons, and neuroradiologists attended on November 7 to 9, 2001, in Tokyo as the 11th Keio University International Symposium for Life Sciences and Medicine. The objectives set for the meeting were as follows: 1. A uniform classification for reporting results should be promoted. 2. The classification should be used by all professionals (general physicians, audiologists, otolaryngologists, neurologists, neurosurgeons, and neuroradiologis ts) involved in the diagnosis and management of vestibular schwannoma. 3. The classification should be easy to learn and practicable for all professionals. 4. The classification should be easily understood by patients. 5. Standard guidelines should be provided that would facilitate interinstitutional comparison of results of surgical studies (1). 6. A new and modified rational version of existing classifications should be provided. The following consensus on reporting systems was achieved:

Surgical Salvage after Failed Irradiation for Vestibular Schwannoma

Objectives/Hypothesis: Compare vestibular schwannoma (VS) surgical outcome between patients with prior irradiation and those not previously treated.

Meniere's disease: prevalence of contralateral ear involvement.

Objective: Determine the prevalence and time interval for conversion from unilateral to bilateral involvement in Menieres disease and cochlear hydrops. Study Design and Setting: Retrospective chart review in a tertiary otologic referral center. Patients: 232 patients diagnosed with Menieres Disease (n = 186) or cochlear hydrops (n = 46) between 1959 and 2001, who visited the clinic over a five-year period between 1997-2001 and have at least 2 audiograms more than 12 months apart. Main Outcome Measures: Prevalence of cochlear hydrops relative to Menieres Disease, rate of progression from unilateral to bilateral involvement; interval between unilateral onset of symptoms and bilateral involvement; and rate of progression from cochlear hydrops to Menieres disease. Results: Initial diagnosis was Menieres disease in 71% and cochlear hydrops in 29% of all 950 hydropic patients presenting between 1997 and 2001. In the study sample, Menieres disease was bilateral at presentation in 11%; an additional 12% (14% of unilaterals) became bilateral during the follow-up period. At presentation, 6.5% of cochlear hydrops patients were bilateral, with another 26% becoming bilateral. Conversion from cochlear hydrops to Menieres disease occurred in 33% and some of these are included among the bilateral. The average time interval for conversion from unilateral to bilateral Menieres was 7.6 years (SD = 7.0 years). Conclusion: Most otologists are aware of the potential for contralateral ear involvement and conversion from cochlear hydrops to Menieres disease after diagnosis. These changes are significant, require long-term follow-up for detection, and may necessitate further treatment. Patients should be counseled regarding this potential when interventions are considered, especially with respect to ablative treatments.

Prevalence of allergy in Meniere’s disease

OBJECTIVES: The goal of this study was to determine the prevalence of allergy in a population of patients with Menieres disease. METHODS: A survey was mailed to all patients with Menieres disease seen at our institution from 1994 to July 1998 (n = 1490). As a control group, 172 patients with otologic problems other than Menieres disease completed the same survey. RESULTS: Of 734 respondents with Menieres disease, 59.2% reported possible airborne allergy, 40.3% had or suspected food allergies, and 37% had had confirmatory skin or in vitro tests for allergy. These prevalence rates were significantly higher than those found in the control group, of which 42.7% reported having or suspecting airborne allergies and 25% had or suspected food allergies (differences all significant at P ≤ 0.005). CONCLUSION: The prevalence of allergy appears to be much higher in patients with Menieres disease than in the general population or the population of patients visiting an otologic clinic for other symptoms. (Otolaryngol Head Neck Surg 2000;123: 69-75.)

Acoustic tumors: Effect of surgical removal on tinnitus

Tinnitus is common in patients with acoustic tumors and may be the initial symptom leading to diagnosis. We might anticipate that tumor removal would alleviate preoperative tinnitus. However, few have studied this systematically. Further, the effect of tumor removal in those with no preoperative tinnitus has rarely been examined. In this study, a questionnaire was sent retrospectively to patients who had undergone surgical removal of an acoustic tumor, addressing the characteristics of tinnitus, and asking whether surgery had directly affected tinnitus. A total of 134 questionnaires were returned. Those who indicated preoperative tinnitus tended to show small but statistically significant improvements in the perceived severity of the tinnitus after surgery, although the symptom rarely resolved entirely. Those with no preoperative tinnitus have an approximately 50 percent chance of developing it following surgery.

Evaluation of the increased use of partial resection of large vestibular schwanommas: facial nerve outcomes and recurrence/regrowth rates.

Objective To determine whether partial tumor removal in large vestibular schwannoma improves facial nerve outcomes while maintaining a low risk of tumor regrowth/recurrence. Study Design Retrospective chart review and prospective database. Setting Tertiary neurotologic referral center. Patients Four hundred patients with a vestibular schwannoma of 2.5 cm or greater in maximum diameter undergoing translabyrinthine microsurgical resection from 2001 to 2011. There were 325 gross total resections (GTR), 44 near total resections (NTR), and 31 subtotal resections (STR), with an overall mean tumor size of 3.2 cm (standard deviation, 0.7). Intervention(s) Translabyrinthine surgical tumor resection. Main Outcome Measures House-Brackmann (H-B) facial nerve grade postoperatively and at 1 year, tumor regrowth/recurrence (≥2 mm), additional treatment, and complications. Results Higher rates of H-B facial nerve Grades I and II were achieved at both the postoperative and 1-year follow-ups in the NTR (78%, 97%) and STR (71%, 96%) groups compared with GTR (53%, 77%) (p ⩽ 0.001). Eye treatment, medical or surgical, was required more often in GTR (28.0%) than NTR and STR (8% and 21%, respectively, p ⩽ 0.04), with no other differences in complications. The NTR and STR groups had a significantly higher rate of regrowth than GTR resection (21% and 22% versus 3%) (p ⩽ 0.001) at average follow-up times of 3.7, 3.7, and 5.1 years, respectively, and need for further treatment occurred at a higher rate, although infrequently, in NTR and STR (2% and 10% versus 0%) (p ⩽ 0.001). Conclusion Near total and subtotal removal in large tumors are viable treatment options to maintain facial nerve function. During the follow-up period examined in this study, there was a low risk of need for further treatment. Longer-term follow-up is needed to better assess the need for retreatment in patients treated with NTR and STR.

Radiation therapy for the treatment of vestibular schwannoma: a critical evaluation of the state of the literature.

Objective: Review publications reporting radiation treatment of vestibular schwannomas (VS) and describe how data, patient characteristics, and study endpoints were reported. Data Sources: PubMed search for English language articles on radiation treatment of VS published from January 2002 to July 2007. Study Selection: Studies presenting outcomes were selected, yielding 56 articles (58 studies) in journals of neurosurgery (30), oncology (18), otolaryngology (6), and other (2). Data Extraction/Synthesis: Data included type of study, number of subjects, demographics, follow-up times, type of radiation, tumor size, tumor control definition, control rates, facial nerve function measure and outcome, type of hearing and vestibular testing and outcomes, and complications. Descriptive statistics were performed. Results: Studies (72.9%) were retrospective reviews with stated sample sizes ranging from 5 to 829. Gamma-knife (49.2%), linear accelerator (35.6%), and proton beam (6.8%) were used with various doses. Average follow-up was less than 5 years in 79.6% of studies, and 67.4% included patients at less than or equal to 1 year. Tumor size was reported as diameter (23.7%), volume (49.2%), both (11.9%), other (3.4%), or not reported (11.9%). Definition of tumor control varied: less than or equal to 2 mm growth (22.0%), no visible/measurable change (16.9%), required surgery (10.2%), other (17.0%), and not clearly specified (33.9%). Facial nerve outcome was reported as House-Brackmann (64.4%), normal/abnormal (11.9%), other (1.7%), or was not reported (22%). Conclusion: The lack of uniform reporting criteria for tumor control, facial function and hearing preservation, and variability in follow-up times make it difficult to compare studies of radiation treatment for VS. We recommend consideration of reporting guidelines such as those used in otology for reporting VS resection results.

Open-set speech recognition in children with a single-channel cochlear implant

We evaluated the ability of profoundly deaf children using the 3M/House single-channel cochlear implant to understand speech without the aid of speechreading. Fifty-one implanted children over the age of 5 years, who had sufficient cognitive and language skills, were tested using word and sentence stimuli presented in an open-set, auditory-only mode. Fifty-two percent of the children demonstrated some open-set performance on word identification, while 41.5% did so on sentence comprehension. Children who scored open-set had a shorter duration of deafness than those who did not. A larger proportion of children using oral communication demonstrated open-set speech recognition than those using total communication. A multiple regression analysis indicated that communication method accounted for the largest proportion of variability in performance on both the word and sentence tasks. Children achieving open-set auditory recognition, however, included both those using oral communication and those using total communication, children deafened by meningitis and those born deaf, and children with varying durations of deafness.

Present Status and Future Directions of the Ear Research Institute Cochlear Implant Program

Thirty-three adult subjects have been implanted with single-electrode cochlear implants at the Ear Research Institute. This paper outlines the current status of the subjects; the rehabilitation and testing program; results found with the implant; and future directions of the implant program. Results indicate that implant subjects can score significantly above chance on a variety of discrimination tests. Implant subjects also score significantly better than hearing aid subjects on these tests. Research is continuing on engineering and signal-processing improvements for the single-elecrode implant. Multiple-electrode implants and binaural implants are being considered for future research at the Ear Research Institute.

Allergy and Its Relation to Meniere's Disease

Ménières disease (MD), which by definition is idiopathic, has been ascribed to various causes, including inhalant and food allergies. Patients with MD report higher rates of allergy history and positive skin or in vitro tests compared with a control group of patients with other otologic diseases and to the general public. Recent immunologic studies have shown higher rates of circulating immune complexes, CD4, and other immunologic components in patients with MD compared with normal controls. Published treatment results have shown benefit from immunotherapy and/or dietary restriction for symptoms of MD in patients who present with allergy and MD.