Per Cayé-Thomasen

The natural history of vestibular schwannoma.

Objective: The incidence of vestibular schwannomas (VSs) approaches 20 per million/yr. As treatment may depend on tumor growth, there is a demand of a treatment strategy based on hard data on the growth pattern of these tumors. This article reports growth data registered prospectively in 552 patients. Study Design: Of the 1,818 consecutive patients, diagnosed with VS during the period from 1975 to 2005, 729 patients were allocated to observation by repetitive magnetic resonance imaging. At least two scans had been performed in 552 patients at the time of data analysis. Two hundred thirty patients had a tumor confined to the internal acoustic meatus, whereas 322 patients had a tumor with an extrameatal extension. Growth to extrameatal extension was the definition for growth in intrameatal tumors, whereas a largest diameter change of more than 2 mm was the criteria for growth/shrinkage of extrameatal tumors. The mean observation time was 3.6 years (range, 1-15 yr). Results: Seventeen percent of the intrameatal tumors grew, whereas significantly more of the extrameatal tumors displayed growth during the period (28.9%). Growth occurred within the first 5 years after diagnosis. No correlation could be demonstrated between tumor growth rate, sex, or age. Conclusion: VS growth occurs within the first 5 years after diagnosis in a limited number of tumors, primarily in tumors with an extrameatal extension. We found no relation between tumor growth and sex or age. These findings justify primary observation of small tumors. A treatment strategy is proposed for this disease, focusing on the patient group allocated to observation.

True incidence of vestibular schwannoma

BACKGROUND:The incidence of diagnosed sporadic unilateral vestibular schwannomas (VS) has increased, due primarily to more widespread access to magnetic resonance imaging. OBJECTIVE:To present updated epidemiological data on VS incidence, as well as patient age, hearing acuity, tumor size, and localization at diagnosis for the last 4 decades in an unselected population, with emphasis on developments in recent years. METHODS:From 1976 to 2008, 2283 new cases of VS were diagnosed and registered in a national database covering 5.0 to 5.5 million inhabitants. Incidence during the period, patient sex and age, data on hearing (pure tone average and speech discrimination), and tumor size at diagnosis were retrieved from the database. RESULTS:The incidence increased from 3.1 diagnosed VS per million per year in 1976 to a peak of 22.8 VS per million per year in 2004, which was followed by a decrease to 19.4 VS per million per year in 2008. Mean tumor size at diagnosis decreased from 30 mm in 1979 to 10 mm in 2008, whereas hearing acuity at diagnosis has improved over the years. CONCLUSION:After a steady increase over the last 4 decades, the incidence of vestibular schwannomas appears to have peaked and decreased in recent years, stabilizing at about 19 tumors per million per year. Whereas the sex ratio and age at diagnosis have remained grossly unchanged over the years, hearing has improved, and tumor size has decreased considerably.

Epidemiology and natural history of vestibular schwannomas.

This article describes various epidemiologic trends for vestibular schwannomas over the last 35 years, including a brief note on terminology. Additionally, it provides information on the natural history of tumor growth and hearing level following the diagnosis of a vestibular schwannoma. A treatment strategy based on the natural history of tumor growth and hearing also is discussed.

The efficacy and safety of once-daily mometasone furoate nasal spray in nasal polyposis : a randomized, double-blind, placebo-controlled study

Conclusion. In subjects with mild-to-moderate nasal polyposis, treatment with mometasone furoate nasal spray (MFNS) 200 µg once daily (QD) significantly decreases nasal congestion, reduces polyp size, and improves quality of life. Objectives. To evaluate the efficacy and safety of MFNS, administered QD in the morning, in subjects with mild-to-moderate nasal polyposis. Subjects and methods. This randomized, double-blind, double-dummy, placebo-controlled clinical trial enrolled subjects with mild-to-moderate nasal polyposis at 12 centers in Denmark, Finland, Norway, and Sweden. Inclusion criteria were: age ≥ 18 years, a diagnosis of bilateral nasal polyps, and clinically significant nasal congestion. Following a 2–4-week run-in period, subjects were randomized to receive MFNS 200 µg QD or matching placebo for 16 weeks. Results. A total of 298 subjects were randomized to treatment. Of those subjects included in the intent-to-treat efficacy analysis (n = 291), a statistically greater proportion of the MFNS group than the placebo group had improvements in investigator-assessed nasal congestion score between baseline and end point (the primary outcome) (74.3% vs 46.8%; p < 0.001). Significant benefits of MFNS were also seen for secondary end points, including polyp size, sense of smell, peak nasal inspiratory flow, therapeutic improvement, and quality-of-life measures. MFNS was well tolerated, with no unusual or unexpected adverse events.

VEGF and VEGF receptor-1 concentration in vestibular schwannoma homogenates correlates to tumor growth rate.

Objective: Vascular endothelial growth factor (VEGF) is one of the most potent mediators of angiogenesis, which is a mandatory process during tumor growth. Immunohistochemical studies have demonstrated VEGF expression in vestibular schwannomas (VS), and a semi-quantitation of staining intensity indicated a correlation between tumor growth rate and VEGF expression. The present objectives were to determine the concentration of VEGF and the high-affinity receptor VEGFR-1 in VS homogenates and to examine a possible correlation with symptom duration, tumor size, or growth rate. Study Design, Patients, and Methods: Prospective selection of 27 patients with VS growth determined by repeated magnetic resonance imaging. Patient files were reviewed for symptom duration and all magnetic resonance images reviewed for determination of tumor size and growth rate. ELISA was used for determination of the VEGF and VEGFR-1 concentration in tumor homogenates. Setting: Tertiary University Hospital Clinic. Results: All tumor homogenates contained VEGF and VEGFR-1. A significant correlation existed between the concentration of both VEGF and VEGFR-1 and tumor growth rate but not symptom duration or tumor size. Conclusion: The concentration of VEGF and VEGFR-1 in VS homogenates correlates with tumor growth rate but not with tumor size or symptom duration. We conclude that VEGF and VEGFR-1 appear to be directly involved in the growth pattern of VS.

Self-esteem and social well-being of children with cochlear implant compared to normal-hearing children.

OBJECTIVE The purpose of this study was to make a quantitative comparison of parameters of self-esteem and social well-being between children with cochlear implants and normal-hearing children. MATERIAL AND METHODS Data were obtained from 164 children with cochlear implant (CI) and 2169 normal-hearing children (NH). Parental questionnaires, used in a national survey assessing the self-esteem and well-being of normal-hearing children, were applied to the cochlear implanted group, in order to allow direct comparisons. RESULTS The children in the CI group rated significantly higher on questions about well-being in kindergarten/school and the CI boys appeared to manage school work better than normal-hearing boys. CI children were significantly more active and bullied other children less than normal-hearing peers, whereas no difference existed as to being bullied by other children. No difference was obtained regarding overall self-esteem or number of friends. The two groups of children scored similarly on being confident, independent, social, not worried and happy. CONCLUSION Children with cochlear implant score equal to or better than their normal-hearing peers on matters of self-esteem and social well-being.

Hearing in Patients with Intracanalicular Vestibular Schwannomas

This paper reports data on the spontaneous course of hearing in 156 patients with purely intracanalicular vestibular schwannomas. The mean pure tone average (PTA) was 51 dB HL and the mean speech discrimination score (SDS) 60% at diagnosis. The risk of a significant subsequent hearing loss (≧10 dB PTA or ≧10% SDS) was 54% during 4.6 years of observation. Patients with normal speech discrimination at diagnosis had a significantly smaller risk of loosing hearing. The hearing loss at diagnosis and during observation was not related to age, gender, diagnostic tumor size, tumor- induced expansion of the internal auditory canal or tumor sublocalization (fundus, central or porus). However, the loss of PTA was smaller in shrinking tumors and the PTA deterioration rate correlated with the volumetric tumor growth rate. After 4.6 years observation, the PTA had increased by 14 dB to 65 dB HL, and the SDS reduced by 17% to 43%. The proportion of patients eligible for hearing preservation treatment as determined by word recognition score class I (70–100% SDS) was reduced to 28% (a 44% reduction), and by AAO-HNS class A to 9% (a 53% reduction).

Immunohistochemical Demonstration of Vascular Endothelial Growth Factor in Vestibular Schwannomas Correlates to Tumor Growth Rate

Objective Vascular endothelial growth factor (VEGF) is one of the most potent mediators of angiogenesis, which is a mandatory process during tumor growth. The present objectives were to determine expression of VEGF in vestibular schwannomas by immunohistochemistry and to examine a possible correlation with symptom duration, tumor size, or growth rate.

Unexpected findings and surgical complications in 505 consecutive cochlear implantations: a proposal for reporting consensus

Conclusion: Cochlear implantation is a safe procedure in experienced hands, as the rate of severe complications is below 2%. Complications differ between children and adults, and transient disequilibrium/vertigo is the most common complication, followed by wound infection, haematoma/oedema and transient chorda tympani syndrome. An international consensus on the reporting of complications is proposed, as a high degree of variability occurs in the literature, which precludes an overview necessary for adequate patient information and for incentives aimed at prevention. Objective: To report unexpected findings and surgical complications in 505 consecutive cochlear implantations, and propose a consensus for reporting complications. Methods: This was a retrospective file review of 367 consecutive patients (505 implantations), of which 187 children had received 313 implants and 180 adults 192 implants. Results: The overall complication rate was 29.1%, with a major complication rate of 1.8%. When deducting vertigo/disequilibrium, the overall complication rate was 18.3%. Adults had a complication rate of 58.8%, 1.6% being major. Vertigo/disequilibrium was the most common complication (25%), followed by wound infection (8.9%) and transient chorda tympani syndrome (5.7%). In the paediatric group, complications occurred in 14.7%, 1.9% being major. The children suffered most frequently from wound infection (3.8%), vertigo/disequilibrium (2.2%) and haematoma/oedema (2.2%).

A comparison of cartilage palisades and fascia in tympanoplasty after surgery for sinus or tensa retraction cholesteatoma in children.

Objective: To compare cartilage palisades with fascia grafting in reconstruction of the eardrum after surgery for sinus or tensa retraction cholesteatoma in children, with respect to postoperative drum retraction and perforation, cholesteatoma recurrence, and hearing. Material: From March 1995 to October 2000, a total of 64 children, aged 5 to 15 years, underwent surgery for either sinus or tensa retraction cholesteatoma. The eardrum was reconstructed using cartilage palisades in 32 children and fascia or perichondrium in 32 children. Postoperatively, the patients were seen as out-patients and were recently reevaluated by otomicroscopy and audiometry. Main Outcome Measures: Postoperative drum retraction and perforation, cholesteatoma recurrence, and hearing (pure tone average, speech reception threshold, and air–bone gap). Results: All patients in the palisade group and all but one patient in the fascia group attended the follow-up examination. In the palisade group, the mean follow-up period was 37 months (range, 3–65 mo) and in the fascia group 52 months (range, 17–75 mo). Two (6%) retractions and no perforations were found in the palisade group, versus 12 (36%) retractions and 4 perforations (12%) in the fascia group at follow-up (both significant differences). No cholesteatoma recurrence occurred. Late hearing results in sinus cholesteatomas were significantly better in the palisade group. Conclusions: The comparison of fascia and cartilage palisade grafting for drum reconstruction after tensa cholesteatoma surgery in children indicates that the palisade technique may be superior in respect to prevention of drum retraction and perforation. Further, in sinus cholesteatoma surgery, the long-term hearing results are better when grafting cartilage palisades.