The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia.
OBJECTIVE
The primary aim of this study was to evaluate the incidence and discuss the pathogenesis of high-frequency hearing loss (HFHL) after microvascular decompression (MVD) for trigeminal neuralgia (TGN), glossopharyngeal neuralgia (GPN), or geniculate neuralgia (GN).


METHODS
The authors analyzed preoperative and postoperative audiogram data and brainstem auditory evoked potentials (BAEPs) from 93 patients with TGN, 6 patients with GPN, and 8 patients with GN who underwent MVD. Differences in pure tone audiometry > 10 dB at frequencies of 0.25, 0.5, 1, 2, 4, and 8 kHz were calculated preoperatively and postoperatively for both the ipsilateral and the contralateral sides. Intraoperative monitoring records were analyzed and compared with the incidence of HFHL, which was defined as a change in pure tone audiometry > 10 dB at frequencies of 4 and 8 kHz.


RESULTS
The incidence of HFHL was 30.84% on the side ipsilateral to the surgery and 20.56% on the contralateral side. Of the 47 patients with HFHL, 20 had conductive hearing loss, and 2 experienced nonserviceable hearing loss after the surgery. The incidences of HFHL on the ipsilateral side at 4 and 8 kHz were 17.76% and 25.23%, respectively, and 8.41% and 15.89%, respectively, on the contralateral side. As the audiometric frequency increased, the number of patients with hearing loss increased. No significant postoperative difference was found between patients with and without HFHL in intraoperative BAEP waveforms. Sex, age, and affected side were not associated with an increase in the incidence of hearing loss.


CONCLUSIONS
High-frequency hearing loss occurred after MVD for TGN, GPN, or GN, and the greatest incidence occurred on the ipsilateral side. This hearing loss may be a result of drill-induced noise and/or transient loss of cerebrospinal fluid during the course of the procedure. Changes in intraoperative BAEP waveforms were not useful in predicting HFHL after MVD. Repeated postoperative audiological examinations may be useful in assessing the prognosis of HFHL.
Departments of 1 Neurological Surgery and.|Neurology, and.
Parthasarathy
P
Thirumala
Schools of Emergency Medicine and Medicine, University of Pittsburgh, Pennsylvania.
Kristin
K
Meigh
Departments of 1 Neurological Surgery and.
Navya
N
Dasyam
Departments of 1 Neurological Surgery and.
Preethi
P
Shankar
Departments of 1 Neurological Surgery and.
Kanika R K
KR
Sarma
Departments of 1 Neurological Surgery and.
Deepika R K
DR
Sarma
Departments of 1 Neurological Surgery and.
Miguel
M
Habeych
Departments of 1 Neurological Surgery and.
Donald
D
Crammond
Departments of 1 Neurological Surgery and.
Jeffrey
J
Balzer
D000328:Adult; D000368:Aged; D005260:Female; D020435:Glossopharyngeal Nerve Diseases / Q000601:surgery*; D006316:Hearing Loss, High-Frequency / Q000175:diagnosis / Q000453:epidemiology*; D016697:Herpes Zoster Oticus / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D014277:Trigeminal Neuralgia / Q000601:surgery*
BAEP = brainstem auditory evoked potential; GN = geniculate neuralgia; GPN = glossopharyngeal neuralgia; HFHL = high-frequency hearing loss; HFS = hemifacial spasm; IPL = interpeak latency; MVD = microvascular decompression; PTA = pure tone average; TGN = trigeminal neuralgia; auditory brainstem response; geniculate neuralgia; glossopharyngeal neuralgia; high-frequency hearing loss; microvascular decompression; pain; pure tone audiometry; trigeminal neuralgia; wV = Wave V