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Improved Recovery after Vestibular Schwannoma Excision with Intratympanic Gentamicin Prehabilitation.
Trudel, Mathieu; Stapleton, Emma J; Wadeson, Andrea M; Spiller, William; North, Hannah J; Heal, Calvin; Sebastian, Joseph; Freeman, Simon R; Rutherford, Scott A; Entwistle, Helen; Hammerbeck-Ward, Charlotte L; Pathmanaban, Omar; King, Andrew T; Lloyd, Simon K W.
Afiliação
  • Trudel M; Department of Otolaryngology Head and Neck Surgery, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, UK.
  • Stapleton EJ; Department of Otolaryngology-Head and Neck Surgery, CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, Quebec City, Quebec, Canada.
  • Wadeson AM; Department of Otolaryngology Head and Neck Surgery, Manchester Royal Infirmary, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
  • Spiller W; Department of Neurosurgery, Salford Royal Hospital, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK.
  • North HJ; Department of Otolaryngology Head and Neck Surgery, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, UK.
  • Heal C; Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
  • Sebastian J; Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
  • Freeman SR; Department of Anaesthesia, Salford Royal Hospital, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK.
  • Rutherford SA; Department of Otolaryngology Head and Neck Surgery, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, UK.
  • Entwistle H; Department of Otolaryngology Head and Neck Surgery, Manchester Royal Infirmary, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
  • Hammerbeck-Ward CL; Department of Neurosurgery, Salford Royal Hospital, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK.
  • Pathmanaban O; Department of Neurosurgery, Salford Royal Hospital, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK.
  • King AT; Department of Neurosurgery, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
  • Lloyd SKW; Department of Neurosurgery, Salford Royal Hospital, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK.
Laryngoscope ; 134(7): 3316-3322, 2024 Jul.
Article em En | MEDLINE | ID: mdl-38332515
ABSTRACT

OBJECTIVE:

Translabyrinthine excision of a vestibular schwannoma is associated with acute vestibular failure. Preoperative intratympanic gentamicin (ITG) injections can improve objective balance function after surgery but its clinical benefits remain to be established.

METHODS:

Adult patients undergoing translabyrinthine removal of a vestibular schwannoma between January 2014 and February 2018 underwent preoperative vestibular function testing. Patients were divided in to 3 groups, those with vestibular function (VF) who received ITG injections, those with VF but did not receive ITG and those with no VF. Groups were compared according to degree of vertigo, length of stay, time to unassisted mobilization, and postoperative anti-emetic consumption.

RESULTS:

Forty six patients had ITG injections (Group 1), 7 had residual VF but refused treatment (Group 2), 21 had no VF (Group 3). Group 1 had a significant improvement in vertigo over time whereas groups 2 and 3 did not. There was a statistically significant 70% decrease in time to independent mobilization between Group 1 and other groups and a 19% decrease in length of stay in Group 1 compared to other groups although this did not reach statistical significance. Two patients had injection-related complications. Group 1 used less anti-emetics than other groups but this was not statistically significant.

CONCLUSION:

Preoperative intratympanic gentamicin injection with vestibular rehabilitation exercises is associated with less postoperative vertigo and earlier postoperative mobilization. There was reduced duration of hospitalization and decreased consumption of anti-emetic but not significantly so possibly because of low numbers of patients in the no treatment group. LEVEL OF EVIDENCE 2 Laryngoscope, 1343316-3322, 2024.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cuidados Pré-Operatórios / Gentamicinas / Neuroma Acústico Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cuidados Pré-Operatórios / Gentamicinas / Neuroma Acústico Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article