J Neurol Surg B Skull Base 2019; 80(S 01): S1-S244
DOI: 10.1055/s-0039-1679627
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Hearing Preservation Outcomes and Prognostic Factors in Acoustic Neuroma Surgery: A Prediction of Cutoff Values

Elisabetta Zanoletti
1   Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
,
Diego Cazzador
1   Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
,
Daniele Borsetto
1   Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
,
Annachiara Frigo
2   Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
,
Alessandro Martini
1   Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
,
Antonio Mazzoni
1   Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
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Publikationsdatum:
06. Februar 2019 (online)

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    Background: Early diagnosis of small acoustic neuromas (AN) dictates the need for adequate surgical management of patients with good hearing. The retrosigmoid approach combined with a retrolabyrinthine meatotomy provides tumor removal with a chance of hearing preservation.

    Objective: The aim of the study was to analyze the rate of hearing preservation surgery (HPS) and to determine independent prognostic factors of good hearing. Furthermore, the optimal cutoff points of good postoperative hearing were sought for preoperative continuous variables.

    Methods: The medical charts of 100 consecutive patients who underwent AN removal and HPS from 2000 to 2012 were retrospectively reviewed. Hearing results were stratified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification and to the Tokyo classification, also known as Sanna-modified hearing classification.

    Results: According to the AAO-HNS classification, preoperative class A was retained 39% of cases after surgery. Preoperative tumor size, pure tone average (PTA), and auditory brainstem response (ABR) were predictors of hearing preservation. Patients with absent or highly impaired preoperative ABR demonstrated a significantly higher risk of postoperative hearing loss than patients with preoperative normal or slightly impaired ABR (OR = 13.38). Cutoff thresholds for good hearing outcomes according to tumor size and PTA were 7 mm and 21 dB, respectively. At multivariable analysis, extrameatal tumor size > 7 mm (OR = 6.38) and PTA > 21 dB (OR = 6.45) resulted independent predictive factors for postoperative hearing. The C-index for calculating the model’s goodness-of-fit was 0.784.

    Conclusion: In conclusion, based on the calculated cutoff values of predictors, accurate preoperative audiological assessment and patient selection for HPS is recommended.


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    Die Autoren geben an, dass kein Interessenkonflikt besteht.