title: Patient-perceived long-term communication and swallow function following cerebellopontine angle surgery.
abstract: OBJECTIVE
  Evaluation of long-term patient-perceived functional outcomes and quality of life (QOL) related to communication and eating with an emphasis on voice, speech production, and swallowing after cerebello-pontine angle (CPA) surgery.
  
  
  METHODS
  Prospective cross-sectional study.
  
  
  METHODS
  The MD Anderson Dysphagia Inventory (MDADI), Voice Handicap Index (VHI), and Facial Clinimetric Evaluation (FaCE) surveys were distributed to patients who underwent CPA surgery between January 2008 and December 2010. Immediate postoperative cranial nerve function extracted from medical records was compared to long-term patient-perceived function and associated QOL.
  
  
  RESULTS
  There was a 61% response rate with a mean postoperative period of 31.6 months (range 15-49). The presence of facial palsy in the postoperative period and the corresponding House-Brackmann (H-B) score were the strongest predictors of patient-perceived long-term function and QOL in all three domains (P < .005). Postoperative vagal palsy by comparison was not associated with long-term disturbance of voice or speech function. Postoperative dysphagia had a particularly large association with perceived long-term facial function and related QOL (P < .0005), with a smaller but significant impact on perceived swallow outcome (P < .05). After adjusting for other variables, the postoperative H-B score remained a significant predictor of perceived long-term facial and voice function and related QOL.
  
  
  CONCLUSIONS
  Patients with severe facial dysfunction following surgery to the CPA are at increased risk for long-term self-reported difficulties with communication and eating, even with improvement of vagal function. Speech and swallow therapy should therefore be provided to these patients whether or not they also have pharyngeal dysphagia or voice disturbance.
  
  
  METHODS
  2b.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland, U.S.A.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Starmer
authors.forename: Bryan K
authors.initials: BK
authors.lastname: Ward
authors.forename: Simon R A
authors.initials: SR
authors.lastname: Best
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.forename: Lee M
authors.initials: LM
authors.lastname: Akst
authors.forename: Alexander
authors.initials: A
authors.lastname: Hillel
authors.forename: Henry
authors.initials: H
authors.lastname: Brem
authors.forename: Howard W
authors.initials: HW
authors.lastname: Francis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001290:Attitude; D002530:Cerebellopontine Angle / Q000601:surgery*; D003430:Cross-Sectional Studies; D003679:Deglutition / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D013060:Speech / Q000502:physiology*; D013997:Time Factors; D014831:Voice / Q000502:physiology*
keywords: Vestibular schwannoma; acoustic neuroma; dysphagia; long-term; quality of life; speech; swallowing; voice