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Rate of Initial Hearing Loss During Early Observation Predicts Time to Non-Serviceable Hearing in Patients With Conservatively Managed Sporadic Vestibular Schwannoma.
Otol Neurotol 2019; 40(10):e1012-e1017ON

Abstract

OBJECTIVE

To date, prediction models for estimating risk of acquiring non-serviceable hearing in subjects with observed vestibular schwannoma (VS) have evaluated outcomes primarily based on features at initial diagnosis. Herein, we evaluate the association of rate of hearing decline during the initial period of observation with time to non-serviceable hearing. If significant, rate of hearing decline may inform decision making after an introductory period of observation.

SETTING

Two tertiary care centers.

PATIENTS

VS patients with serviceable hearing who underwent at least three audiograms and two magnetic resonance imaging (MRI) studies before intervention or being lost to follow-up. The rate of change in pure-tone average (PTA) and word recognition score (WRS) was calculated as the score from the second audiogram minus the score from the first audiogram, divided by the duration in months between the two.

MAIN OUTCOME MEASURE(S)

Serviceable hearing, defined as PTA ≤50 dB HL and WRS ≥50%.

RESULTS

Among 266 patients meeting inclusion criteria, 52 developed non-serviceable hearing at last follow-up. Kaplan-Meier estimated rates of maintaining serviceable hearing (95% CI; number still at risk) at 1, 3, 5, 7, and 10 years were 97% (95-100; 206), 78% (72-85; 98), 68% (60-77; 39), 60% (50-73; 17), and 44% (29-67; 2), respectively. In a univariable setting, each 1 dB increase per month in the rate of initial PTA change was associated with a 96% increased likelihood of acquiring non-serviceable hearing (hazard ratio [HR] 1.96; 95% CI 1.44-2.68; p < 0.001). Each 1% increase per month in the rate of initial WRS change was associated with a decreased likelihood of acquiring non-serviceable hearing (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.66-0.94; p = 0.009). After multivariable adjustment, both rate of PTA change (HR 2.42; 95% CI 1.72-3.41; p < 0.001) and rate of WRS change (HR 0.81; 95% CI 0.67-0.99; p = 0.043) remained statistically significantly associated with time to non-serviceable hearing.

CONCLUSION

Rate of early PTA and WRS decline during the initial period of observation are significantly associated with time to development of non-serviceable hearing. This information may facilitate accurate patient counseling and inform decision-making regarding prospective disease management.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine.Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine.Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.Department of Otolaryngology, University of North Carolina, Chapel Hill, North Carolina.Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine.Department of Otolaryngology-Head and Neck Surgery, The Otology Group of Vanderbilt University, Vanderbilt University Medical Center, Nashville, Tennessee.Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine.Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31634279

Citation

Carlson, Matthew L., et al. "Rate of Initial Hearing Loss During Early Observation Predicts Time to Non-Serviceable Hearing in Patients With Conservatively Managed Sporadic Vestibular Schwannoma." Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, vol. 40, no. 10, 2019, pp. e1012-e1017.
Carlson ML, Dowling EM, Lohse CM, et al. Rate of Initial Hearing Loss During Early Observation Predicts Time to Non-Serviceable Hearing in Patients With Conservatively Managed Sporadic Vestibular Schwannoma. Otol Neurotol. 2019;40(10):e1012-e1017.
Carlson, M. L., Dowling, E. M., Lohse, C. M., O'Connell, B. P., Driscoll, C. L. W., Haynes, D. S., ... Hunter, J. B. (2019). Rate of Initial Hearing Loss During Early Observation Predicts Time to Non-Serviceable Hearing in Patients With Conservatively Managed Sporadic Vestibular Schwannoma. Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 40(10), pp. e1012-e1017. doi:10.1097/MAO.0000000000002390.
Carlson ML, et al. Rate of Initial Hearing Loss During Early Observation Predicts Time to Non-Serviceable Hearing in Patients With Conservatively Managed Sporadic Vestibular Schwannoma. Otol Neurotol. 2019;40(10):e1012-e1017. PubMed PMID: 31634279.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rate of Initial Hearing Loss During Early Observation Predicts Time to Non-Serviceable Hearing in Patients With Conservatively Managed Sporadic Vestibular Schwannoma. AU - Carlson,Matthew L, AU - Dowling,Eric M, AU - Lohse,Christine M, AU - O'Connell,Brendan P, AU - Driscoll,Colin L W, AU - Haynes,David S, AU - Link,Michael J, AU - Hunter,Jacob B, PY - 2019/10/22/pubmed PY - 2019/10/22/medline PY - 2019/10/22/entrez SP - e1012 EP - e1017 JF - Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology JO - Otol. Neurotol. VL - 40 IS - 10 N2 - OBJECTIVE: To date, prediction models for estimating risk of acquiring non-serviceable hearing in subjects with observed vestibular schwannoma (VS) have evaluated outcomes primarily based on features at initial diagnosis. Herein, we evaluate the association of rate of hearing decline during the initial period of observation with time to non-serviceable hearing. If significant, rate of hearing decline may inform decision making after an introductory period of observation. SETTING: Two tertiary care centers. PATIENTS: VS patients with serviceable hearing who underwent at least three audiograms and two magnetic resonance imaging (MRI) studies before intervention or being lost to follow-up. The rate of change in pure-tone average (PTA) and word recognition score (WRS) was calculated as the score from the second audiogram minus the score from the first audiogram, divided by the duration in months between the two. MAIN OUTCOME MEASURE(S): Serviceable hearing, defined as PTA ≤50 dB HL and WRS ≥50%. RESULTS: Among 266 patients meeting inclusion criteria, 52 developed non-serviceable hearing at last follow-up. Kaplan-Meier estimated rates of maintaining serviceable hearing (95% CI; number still at risk) at 1, 3, 5, 7, and 10 years were 97% (95-100; 206), 78% (72-85; 98), 68% (60-77; 39), 60% (50-73; 17), and 44% (29-67; 2), respectively. In a univariable setting, each 1 dB increase per month in the rate of initial PTA change was associated with a 96% increased likelihood of acquiring non-serviceable hearing (hazard ratio [HR] 1.96; 95% CI 1.44-2.68; p < 0.001). Each 1% increase per month in the rate of initial WRS change was associated with a decreased likelihood of acquiring non-serviceable hearing (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.66-0.94; p = 0.009). After multivariable adjustment, both rate of PTA change (HR 2.42; 95% CI 1.72-3.41; p < 0.001) and rate of WRS change (HR 0.81; 95% CI 0.67-0.99; p = 0.043) remained statistically significantly associated with time to non-serviceable hearing. CONCLUSION: Rate of early PTA and WRS decline during the initial period of observation are significantly associated with time to development of non-serviceable hearing. This information may facilitate accurate patient counseling and inform decision-making regarding prospective disease management. SN - 1537-4505 UR - https://www.unboundmedicine.com/medline/citation/31634279/Rate_of_Initial_Hearing_Loss_During_Early_Observation_Predicts_Time_to_Non-Serviceable_Hearing_in_Patients_With_Conservatively_Managed_Sporadic_Vestibular_Schwannoma L2 - http://dx.doi.org/10.1097/MAO.0000000000002390 DB - PRIME DP - Unbound Medicine ER -