Test-Retest Reliability of the Coordinate Response Measure in Adults with Normal Hearing or Cochlear Implants.

BACKGROUND: Speech perception in noise is especially challenging for cochlear implant (CI) recipients; thus, speech in noise tests are used to clinically evaluate functional hearing with CIs. The coordinate response measure (CRM) corpus can be utilized in an adaptive speech perception test with competing speakers as the masker. Determining the critical difference for CRM thresholds can enable it to be used to evaluate changes in CI outcomes for clinical and research purposes. If a change in CRM exceeds the critical difference, then this would indicate significant improvement or decrement in speech perception. Additionally, this information provides figures for power calculations that could be used for planning studies and clinical trials [Bland JM: An Introduction to Medical Statistics, 2000]. OBJECTIVES: This study determined the test-retest reliability of the CRM for adults with normal hearing (NH) and adults with CIs. The replicability, variability, and repeatability of the CRM were evaluated for the two groups separately. METHOD: Thirty-three NH adults and thirteen adult CI recipients were recruited and tested with the CRM twice, 1 month apart. The CI group was tested with two talkers only, while the NH group was tested with seven talkers as well as two talkers. RESULTS: CRM had better replicability, repeatability and lower variability for the CI adults compared to NH adults. The critical difference (at p < 0.05) in the two-talker CRM speech reception thresholds (SRTs) among CI users was >5.2 dB, and it was >6.2 dB for the NH if an individual were to be tested under two different conditions. The critical difference (at p < 0.05) in the seven-talker CRM SRT was >6.49. The Mann-Whitney U test showed that CI recipients' CRM scores' variance (Mdn = -0.94) was significantly less than the NH group's (Mdn = 2.2) (U = 54, p < 0.0001). Although the NH had significantly better SRTs in the two-talker condition than in the seven-talker condition (t = -20.29, df = 65, p < 0.0001), the Wilcoxon signed ranks test showed no significant difference between the CRM scores' variance in the two conditions (Z = -1, N = 33, p = 0.08). CONCLUSIONS: NH adults had significantly lower CRM SRTs than the CI recipients; t (31.16) = -23.91, p < 0.001. CRM had better replicability, stability and lower variability for the CI adults compared to NH adults.

Is There a Difference in Hospital Stay between Patients undergoing Translabyrinthine or Retrosigmoid Surgery for Vestibular Schwannoma Stratified by Tumor Size?

Objective To date, no European study has compared approach-specific outcome data in vestibular schwannoma (VS) surgery stratified by tumor size. We analyzed hospital length of stay (LOS), intensive therapy/high-dependency unit (ITU/HDU) LOS, and complications in patients undergoing VS surgery via the translabyrinthine (TL) versus retrosigmoid (RS) approaches, stratifying for tumor size. Design Prospective database undergoing retrospective review. Setting Tertiary center. Participants A total of 117 patients with VS undergoing TL ( n = 71) or RS ( n = 46) surgical resection from 2011 to 2016 were analyzed. Data including age, gender, surgical approach, tumor size, hospital, and ITU/HDU LOS and postoperative complications were evaluated. Intervention(s) Therapeutic-VS surgery via either TL or RS approach. Main Outcome Measure(s) LOS (hospital/intensive care unit). Results Hospital LOS was significantly greater in patients undergoing the RS approach versus TL approach in VS between 31 and 40 mm (11 versus 7 days, p < 0.0006). The mean ITU/HDU LOS was greater in the RS group compared with the TL group (4.6 versus 1, p > 0.05). Reported complications were higher in the RS group ( n = 40 versus 22). A post hoc analysis of the 31 to 40 mm group revealed no statistically significant difference in the American Society of Anesthesiologists grade or preoperative performance status. Conclusions In our practice, in VS sized 31 to 40 mm patients stay 4 days longer post RS compared with TL surgery. This translates to £1600 extra per patient in the UK. Our data may inform decision-making during the skull base multidisciplinary team and the consent process to help decide the ideal operative approach for the patient.

Revision surgery for residual or recurrent vestibular schwannoma.

OBJECTIVE: Assess the requirement for and describe the complication rates of revision surgery for vestibular schwannoma. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Patients undergoing surgery for vestibular schwannoma by the Manchester Neurotology Service between 1978 and 2004. INTERVENTION: Surgery. MAIN OUTCOME MEASURE(S): The presence of recurrent or residual tumor; necessity for further treatment; complications from revision surgery. RESULTS: Primary surgery was undertaken on 1,037 tumors, with 866 total (19 recurred), 128 near-total, and 43 subtotal removals. Further treatment was performed for 4 recurrent, 2 near-total, and 11 subtotal excised tumors. Thirty-five revision operations resulted in 14 total (1 recurred), 8 near-total, and 13 subtotal removals. Further treatment was required for 3 near-total and 6 subtotal excisions. Poor preoperative facial function (House-Brackmann Grades 4-6) was present in 9 of the 35 patients. A further 10 deteriorated by at least 3 grades by 1 year postoperatively. Other complications of revision surgery included 3 patients with cerebrospinal fluid leaks, a postoperative hematoma requiring evacuation, 2 cerebrovascular accidents, and 2 patients with new cranial nerve deficits. CONCLUSION: Most residual tumors after primary surgery are successfully managed with watch and rescan. Tumor fragment size is the greatest determinant of revision treatment. After revision surgery, tumor regrowth is much less predictable. Revision surgery is usually considerably more difficult than primary surgery, with a higher complication rate, particularly with regard to the facial nerve. Changing the approach for revision surgery may confer an advantage to facial nerve function.