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Abstract：
Background: Quick and appropriate diagnostics and the use of intraoperative monitoring (IM) of hearing during vestibular schwannoma (VS) resection increase the likelihood of hearing preservation. During surgery, various methods of IM can be used, i.e., auditory brainstem responses (ABRs), transtympanic electrocochleography (TT-ECochG), and direct cochlear nerve action potentials. The aim of the study was to evaluate the prognostic values of IM of hearing using ABR and TT-ECochG in predicting postoperative hearing preservation and to evaluate relationships between them during various stages of surgery. Methods: This retrospective study presents the pre- and postoperative audiological test results and IM of hearing records (TT-ECochG and ABR) in 75 (43 women, 32 men, aged 18-69) patients with diagnosed VS. Results: The preoperative pure tone average hearing threshold was 25.02 dB HL, while after VS resection, it worsened on average by 30.03 dB HL. According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Hearing Classification, before and after (pre/post) surgery, there were 47/24 patients in hearing class A, 9/8 in B, 2/1 in C, and 17/42 in D. In speech audiometry, the average preoperative speech discrimination score at an intensity of 60 dB SPL was 70.93%, and after VS resection, it worsened to 38.93%. The analysis of electrophysiological tests showed that before the tumor removal the I-V ABR interlatencies was 5.06 ms, and after VS resection, it was 6.43 ms. Conclusions: The study revealed correlations between worse postoperative hearing and changes in intraoperatively measured ABR and TT-ECochG. IM of hearing is very useful in predicting postoperative hearing in VS patients and increases the chance of postoperative hearing preservation in these patients.
摘要：
背景：在前庭神经鞘瘤（VS）切除术期间，快速，适当的诊断以及术中听力监测（IM）的使用增加了保留听力的可能性。手术期间,可以使用各种IM方法，即，听觉脑干反应（ABR），经肺心电图（TT-ECochG），和直接的耳蜗神经动作电位。该研究的目的是使用ABR和TT-ECochG评估听力IM的预后价值，以预测术后听力保留，并评估手术各个阶段之间的关系。方法：这项回顾性研究介绍了75例（43例妇女，32人,18-69岁）诊断为VS的患者。结果:术前纯音平均听阈为25.02dBHL,而VS切除后，平均恶化30.03dBHL。根据美国耳鼻咽喉头颈外科学会（AAO-HNS）听力分类，手术前后（前/后），有47/24的病人在听力A级,B中的9/8，2/1在C，和D中的17/42。在言语测听中，在60dBSPL强度下，术前言语辨别得分平均为70.93%，在VS切除后，恶化到38.93%。电生理测试分析表明，在肿瘤切除前，I-VABR间隙为5.06ms，在VS切除后，是6.43ms。结论：该研究揭示了术后听力较差与术中测量的ABR和TT-ECochG变化之间的相关性。听力IM在预测VS患者术后听力方面非常有用，并增加了这些患者术后听力保留的机会。
