@article{GugelGrimmHartjenetal.2021, author = {Gugel, Isabel and Grimm, Florian and Hartjen, Philip and Breun, Maria and Zipfel, Julian and Liebsch, Marina and L{\"o}wenheim, Hubert and Ernemann, Ulrike and Kluwe, Lan and Mautner, Victor-Felix and Tatagiba, Marcos and Schuhmann, Martin Ulrich}, title = {Risk stratification for immediate postoperative hearing loss by preoperative BAER (brainstem auditory evoked response) and audiometry in NF2-associated vestibular schwannomas}, series = {Cancers}, volume = {13}, journal = {Cancers}, number = {6}, issn = {2072-6694}, doi = {10.3390/cancers13061384}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-234165}, year = {2021}, abstract = {Both brainstem auditory evoked potentials (BAEP) and audiometry play a crucial role in neuro-oncological treatment decisions in Neurofibromatosis Type 2 associated (NF2) vestibular schwannoma (VS) as hearing preservation is the major goal. In this study, we investigated the risk of immediate postoperative hearing deterioration (>15 dB and/or 15\% loss in pure-tone average [PTA]/ speech discrimination score [SDS] in a cohort of 100 operated VS (ears) in 72 NF2 patients by retrospective analysis of pre- and postoperative hearing data (PTA, SDS, American Association of Otolaryngology-Head and Neck Surgery [AAO-HNS], and brainstem auditory evoked potential [BAEP] class) taking into account relevant influencing factors, particularly preoperative audiometry and BAEP status and the extent of resection. Immediately after surgery, the hearing was preserved in 73\% of ears and approximately ~60\% of ears kept their hearing classes. Preoperative BAEP (p = 0.015) and resection amount (p = 0.048) significantly influenced postoperative hearing outcome. The prediction model for postoperative hearing deterioration/loss between preoperative BAEP and AAO-HNS class showed increased risk by increasing BAEP class. Twenty-one tumors/ears were identified with large BAEP and AAO-HNS class discrepancies (≥2 points) and were associated with a high (48-100\%) risk of deafness after surgery in ears with preoperative available hearing. Overall, the results were heterogeneous but the better both BAEP and audiometry class before surgery, the higher the chance of hearing maintenance afterwards. Large resection amounts (e.g., 100\% risk in near-total resections) exhibit a significant (p < 0.05) higher risk compared to smaller amounts (e.g., 10/20\% in laser-coagulated/partially resected tumors). Our results emphasized the indispensable role of both hearing monitoring in form of audiometry and neurophysiology (BAEP) in the pre-and perioperative monitoring of NF2-associated VS. Both BAEP and audiometry are good prognostic markers for the postoperative hearing outcome. The extent of resection should be strictly guided by and adjusted to the intraoperative neurophysiological monitoring.}, language = {en} } @article{TopsakalAgrawalAtlasetal.2022, author = {Topsakal, Vedat and Agrawal, Sumit and Atlas, Marcus and Baumgartner, Wolf-Dieter and Brown, Kevin and Bruce, Iain A. and Dazert, Stefan and Hagen, Rudolf and Lassaletta, Luis and Mlynski, Robert and Raine, Christopher H. and Rajan, Gunesh P. and Schmutzhard, Joachim and Sprinzl, Georg Mathias and Staecker, Hinrich and Usami, Shin-ichi and Van Rompaey, Vincent and Zernotti, Mario and Heyning, Paul van de}, title = {Minimally traumatic cochlear implant surgery: expert opinion in 2010 and 2020}, series = {Journal of Personalized Medicine}, volume = {12}, journal = {Journal of Personalized Medicine}, number = {10}, issn = {2075-4426}, doi = {10.3390/jpm12101551}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-288196}, year = {2022}, abstract = {This study aimed to discover expert opinion on the surgical techniques and materials most likely to achieve maximum postoperative residual hearing preservation in cochlear implant (CI) surgery and to determine how these opinions have changed since 2010. A previously published questionnaire used in a study published in 2010 was adapted and expanded. The questionnaire was distributed to an international group of experienced CI surgeons. Present results were compared, via descriptive statistics, to those from the 2010 survey. Eighteen surgeons completed the questionnaire. Respondents clearly favored the following: round window insertion, slow array insertion, and the peri- and postoperative use of systematic antibiotics. Insertion depth was regarded as important, and electrode arrays less likely to induce trauma were preferred. The usefulness of dedicated soft-surgery training was also recognized. A lack of agreement was found on whether the middle ear cavity should be flushed with a non-aminoglycoside antibiotic solution or whether a sheath or insertion tube should be used to avoid contaminating the array with blood or bone dust. In conclusion, this paper demonstrates how beliefs about CI soft surgery have changed since 2010 and shows areas of current consensus and disagreement.}, language = {en} }