Download PDF
CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2021; 10(02): 108-113
DOI: 10.1055/s-0040-1719202
Original Article

Long-term Dysphagia following Acoustic Neuroma Surgery: Prevalence, Severity, and Predictive Factors

Raiene Telassin Abbas-Kayano 
1   Department of Neurosurgery, University of São Paulo, Brazil
,
Davi Jorge Fontoura Solla
1   Department of Neurosurgery, University of São Paulo, Brazil
,
Nicollas Nunes Rabelo 
1   Department of Neurosurgery, University of São Paulo, Brazil
1   Department of Neurosurgery, University of São Paulo, Brazil
,
Marcos de Queiroz Teles Gomes
1   Department of Neurosurgery, University of São Paulo, Brazil
,
Hector Tomas Navarro Cabrera
1   Department of Neurosurgery, University of São Paulo, Brazil
,
Manoel J. Teixeira 
1   Department of Neurosurgery, University of São Paulo, Brazil
,
Eberval Gadelha Figueiredo
1   Department of Neurosurgery, University of São Paulo, Brazil
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background Acoustic neuroma (AN) may compress the cerebellum and brainstem and may cause dysfunction of bulbar cranial nerves.

Objective To describe swallowing function outcomes in the late postoperative period after AN surgery.

Methods This cohort study included patients operated on between 1999–2014, with a mean follow up of 6.4 ± 4.5 years. The swallowing function was assessed through the functional oral intake scale (FOIS). The primary outcome was defined by scores 5 to 1, which implied oral feeding restriction or adaptation. Risks factors were identified through multivariate logistic regression.

Results 101 patients were evaluated. As many as 46 (45.5%) presented dysphagia on the late postoperative period. Women comprised 77.2%, and the mean age was 47.1 ± 16.0 years (range 19–80). Dysphagic patients presented more type II neurofibromatosis (NF II) (32.6% vs. 10.9%, p = 0.007), larger tumors (3.8 ± 1.1 vs. 3.1 ± 1.0 cm, p < 0.001), partial resection (50.0% vs. 85.5%, p < 0.001) and needed more surgeries (≥2, 39.1% vs. 18.2%, p = 0.019). Important peripheral facial palsy (PFP) (House–Brackmann [HB] grade ≥3) was present before the surgery on 47.5% and worsened on 55.4%. Postoperative PFP (p < 0.001), but not preoperative PFP, was predictive of postoperative dysphagia. On multivariate analysis, the following factors were risk factors for dysphagia: NF II (OR 5.54, p = 0.034), tumor size (each 1 cm, OR 2.13, p = 0.009), partial resection (OR 5.23, p = 0.022) and postoperative HB grade ≥3 (OR 12.99, p = 0.002).

Conclusions Dysphagia after AN surgery is highly correlated to postoperative facial motor function. NF II, tumor size, and extent of resection were also predictive of this morbidity in the late postoperative period.

Keywords

neurologic disorders - dysphagia - speech-language disorders and swallowing


Publication History

Article published online:
19 April 2021

© 2021. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Samii M, Matthies C, Tatagiba M. Management of vestibular schwannomas (acoustic neuromas): auditory and facial nerve function after resection of 120 vestibular schwannomas in patients with neurofibromatosis 2. Neurosurgery 1997; 40 (04) 696-705
    CrossrefPubMedGoogle Scholar
  • 2 Nikolopoulos TP, Fortnum H, O’Donoghue G, Baguley D. Acoustic neuroma growth: a systematic review of the evidence. Otol Neurotol 2010; 31 (03) 478-485
    CrossrefPubMedGoogle Scholar
  • 3 Ryzenman JM, Pensak ML, Tew JM Jr. Patient perception of comorbid conditions after acoustic neuroma management: survey results from the acoustic neuroma association. Laryngoscope 2004; 114 (05) 814-820
    CrossrefPubMedGoogle Scholar
  • 4 Harris C. Neurofibromatosis type 2-living with the complications: a case study. J Neurosci Nurs 2005; 37 (03) 156-158
    CrossrefPubMedGoogle Scholar
  • 5 Bento RFBV. Paralisa facial periférica In: Tratado de Otorrinolaringologista. Sao Paulo: Roca 1994: 888-911
    Google Scholar
  • 6 Carvalho A. Preferência mastigatoria em pacientes com paralisia facial periférica de duração igual ou superior a seis meses: estudo clínico e eletromiográfico. São Paulo, Brazil: Faculdade de Medicina da Universidade de São Paulo 2008
  • 7 American Speech-Language-Hearing Association. (n.d.). Adult Dysphagia. (Practice Portal). Available at: www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/. Accessed July 22, 2018
    PubMed
  • 8 Padovani A. Protocolo fonoaudiológico de introdução e transição da alimentação via oral para usuários com risco de disfagia (PITA). São Paulo, Brazil: Faculdade de Medicina da Universidade de São Paulo 2010
  • 9 Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 2005; 86 (08) 1516-1520
    CrossrefPubMedGoogle Scholar
  • 10 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
    CrossrefPubMedGoogle Scholar
  • 11 Tees D, Lofchy N, Rutka J. Deafness, dysphagia and a middle ear mass in a patient with neurofibromatosis type 2. J Otolaryngol 1992; 21 (03) 227-229
    PubMedGoogle Scholar
  • 12 Eibling DE, Boyd EM. Rehabilitation of lower cranial nerve deficits. Otolaryngol Clin North Am 1997; 30 (05) 865-875
    CrossrefPubMedGoogle Scholar
  • 13 Jennings KS, Siroky D, Jackson CG. Swallowing problems after excision of tumors of the skull base: diagnosis and management in 12 patients. Dysphagia 1992; 7 (01) 40-44
    CrossrefPubMedGoogle Scholar
  • 14 Netterville JL, Civantos FJ. Rehabilitation of cranial nerve deficits after neurotologic skull base surgery. Laryngoscope 1993; 103 (11 Pt 2) (Suppl. 60) 45-54
    CrossrefPubMedGoogle Scholar
  • 15 Tucker HM. Rehabilitation of patients with postoperative deficits cranial nerves VIII through XII. Otolaryngol Head Neck Surg (1979) 1980; 88 (05) 576-580
    CrossrefPubMedGoogle Scholar
  • 16 Starmer HM, Best SR, Agrawal Y. et al. Prevalence, characteristics, and management of swallowing disorders following cerebellopontine angle surgery. Otolaryngol Head Neck Surg 2012; 146 (03) 419-425
    CrossrefPubMedGoogle Scholar