Five-year outcomes following hypofractionated stereotactic radiotherapy delivered in five fractions for acoustic neuromas: the mean cochlear dose may impact hearing preservation.

BACKGROUND: The aim of this study was to assess the clinical outcomes of acoustic neuromas (ANs) treated with hypofractionated stereotactic radiotherapy (hypo-FSRT) prescribed at a uniform dose. METHODS: Forty-seven patients with a unilateral AN were treated consecutively with hypo-FSRT between February 2007 and March 2012. Nineteen patients maintained a serviceable hearing status at the beginning of hypo-FSRT. The prescribed dose was 25 Gy delivered in five fractions per week to the isocenter, and the planning target volume was covered by the 80% isodose line. RESULTS: The median follow-up and audiometric follow-up periods were 61 and 52 months, respectively. The estimated tumor control rate at 5 years was 90% (95% CI 76-96). The existence of the cystic component before hypo-FSRT had a significantly worse impact on tumor control (p = 0.02). The estimated hearing preservation rates at 1, 3 and 5 years were 68% (95% CI 42-84), 41% (95% CI 20-62) and 36% (95% CI 15-57), respectively. A borderline significant difference was identified in the mean biological effective dose with an α/ß value of 3 Gy (BED3) to the ipsilateral cochlea between the preserved hearing and hearing loss groups (19 Gy vs. 28 Gy) (p = 0.08). CONCLUSIONS: Hypo-FSRT delivered in five fractions for unilateral ANs may achieve excellent tumor control with no severe facial or trigeminal complications. The mean BED3 in the cochlea may impact the hearing preservation rate. Therefore, the cochlear dose should be as low as possible.

Fatiga auditiva / Auditory fatigue

Introducción y objetivos: Ante posibles pérdidas de audición a causa de sobrecargas sonoras y la escasa referencia de procedimientos objetivos para su estudio, aportamos una técnica que suministra datos precisos sobre el perfil audiométrico y el factor reclutamiento. El objetivo del estudio es la determinación de la fatiga auditiva temporal a través de la respuesta microfónica coclear ante estímulos de sobrecarga de presión sonora y medida del tiempo de recuperación. Material y método: Instrumentación específica para el estudio de microfónicos cocleares, más un generador que nos proporciona estímulos sonoros de diversa intensidad y componente armónico. Utilizamos ratas Wistar. Medimos la respuesta microfónica normal y después el efecto que sobre ella ha ejercido la aportación de sobrecarga acústica. Resultados: Utilizando un tono puro a 60 dB obtenemos una respuesta microfónica. Fatigando de inmediato con 100 dB en la misma frecuencia, a los 15 min obtenemos una pérdida de 11 dB, a partir de los cuales el deterioro se lentifica y no supera los 15 dB. Mediante sonidos de banda compleja aleatoria o ruido blanco no se produce fatiga ni a niveles de 100 dB durante una hora de sobreestímulo. Conclusiones: No existe fatiga a nivel de los receptores sensoriales. El deterioro de la respuesta mediante intenso sobreestímulo posiblemente se deba a alteraciones bioquímicas de desensibilización por agotamiento. La fatiga auditiva en pruebas clínicas subjetivas afecta a tramos supracocleares. Las pruebas de fatiga auditiva encontradas no coinciden con las obtenidas subjetivamente en clínica ni en psicoacústica (AU)

Introduction and objectives: Given the relevance of possible hearing losses due to sound overloads and the short list of references of objective procedures for their study, we provide a technique that gives precise data about the audiometric profile and recruitment factor. Our objectives were to determine peripheral fatigue, through the cochlear microphonic response to sound pressure overload stimuli, as well as to measure recovery time, establishing parameters for differentiation with regard to current psychoacoustic and clinical studies. Material and method: We used specific instruments for the study of cochlear microphonic response, plus a function generator that provided us with stimuli of different intensities and harmonic components. In Wistar rats, we first measured the normal microphonic response and then the effect of auditory fatigue on it. Results: Using a 60 dB pure tone acoustic stimulation, we obtained a microphonic response at 20 dB. We then caused fatigue with 100 dB of the same frequency, reaching a loss of approximately 11 dB after 15 minutes; after that, the deterioration slowed and did not exceed 15 dB. By means of complex random tone maskers or white noise, no fatigue was caused to the sensory receptors, not even at levels of 100 dB and over an hour of overstimulation. Conclusions: No fatigue was observed in terms of sensory receptors. Deterioration of peripheral perception through intense overstimulation may be due to biochemical changes of desensitisation due to exhaustion. Auditory fatigue in subjective clinical trials presumably affects supracochlear sections. The auditory fatigue tests found are not in line with those obtained subjectively in clinical and psychoacoustic trials (AU)