Functional outcome in patients after excision of extracanalicular acoustic neuromas using the suboccipital approach.

An audit of surgery for acoustic neuroma was carried out to determine the frequency and nature of postoperative symptoms and their impact upon the patient's quality of life and vocation. Fifty-six patients were interviewed between 6 months and 5 years (mean 26 months) after surgical excision of an acoustic neuroma. The objective surgical results in these patients are good, with normal or near normal functional preservation rates of 80% for the facial nerve (House-Brackmann grade I/II), and 27.3% for a previously functioning acoustic nerve. Despite this there was no significant overall reduction in the reported occurrence of balance problems, tinnitus, headache and other neurological sequelae of the tumour after surgical excision. In 20% of the patients persistent symptoms, including deafness and facial weakness, had prevented the resumption of former social activities. As a result of these symptoms 8.6% of the patients were certified medically unfit for work, but of those employed preoperatively over 70% had returned to their jobs. The success of neuro-otological surgical management of acoustic neuroma is offset by some degree of chronic morbidity. Our patients expressed the need to know whether their symptoms would resolve, but were often too afraid to ask. Patients can be reassured that the majority resume their former social and vocational activities, but should be advised that some symptoms can persist or occur de novo after surgery. Our data suggest that early intervention would reduce the incidence of these troublesome sequelae.

Tympanometry, stapedius reflex and hearing impairment in children with otitis media with effusion.

The study assessed the relationship between tympanometry, stapedius reflex and pure tone audiometric hearing impairment. A total of 581 audiograms and typanograms from 370 children aged between 3 and 10 years were studied. Only one ear was examined. Measurements of the pure tone air conduction thresholds (PTACT) were made: firstly as an average of the thresholds from 500, 1,000, and 2,000 Hz, secondly as an average of six frequencies from 250 Hz to 8 Hz. The mean PTACT were calculated for each year of age and for each type of tympanogram. Tympanograms were further subdivided by the presence or absence of the stapedius reflex. The sensitivity, specificity and predictive value of a type B tympanogram were investigated for different ages in relation to mean six frequency PTACT at 20, 25 and 30 dB HL. The results were used to show the accuracy of a type B tympanogram in detecting hearing impairment in children of different ages. The results suggest that tympanometry may be used to screen younger children with otitis media with effusion for hearing impairment, without the need for a pure tone audiogram.