Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2019
Morbidity of Vestibular Schwannomas as Documented by Treating Providers.
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Nuño Miriam, Ugiliweneza Beatrice, Boakye Maxwell, Monfared Ashkan
Аннотация
OBJECTIVE: Characterize the morbidity associated with vestibular schwannoma (VS) as documented by treating providers.
STUDY DESIGN: Retrospective analysis of the MarketScan database.
SETTING: MarketScan database.
SUBJECTS AND METHODS: A study of morbidity in VS patients who underwent treatment between 2002 and 2012 was conducted. A detailed account of morbidity at multiple time points before and after treatment was described.
RESULTS: Of 3,355 patients treated for VS, 2,029 (60.5%) underwent surgery and 1,326 (39.5%) radiation. The average (SD) age of diagnosis was 52.5 (12.1) years. Patients were followed for a mean (SD) of 29.1 (24.2) months before and 39.2 (30.5) months after treatment. Hearing loss (65.4%), vertigo (28.0%), tinnitus (24.7%), and headache (15.2%) were the most documented symptoms at 6 months before treatment. At this juncture, higher rates of hearing loss (71.6 versus 58.6%, p < 0.0001), vertigo (32.3 versus 21.4%, p<0.0001), and tinnitus (26.9 versus 21.5%, p=0.0004) were reported for the surgery cohort. At 6 months posttreatment, surgery cohort were reported to have higher rates of hearing loss (OR 2.15, 95% CI: 1.82-2.52), vertigo (OR 1.56, 95% CI: 1.23-1.96), balance (OR 4.17, 95% CI: 3.03-5.56), facial weakness (OR 10.0, 95% CI: 6.67-14.29), headache (OR 1.56, 95% CI: 1.23-1.96), fatigue (OR 2.22, 95% CI: 1.19-4.17), and swallowing difficulties (OR 2.33, 95% CI: 1.43-3.70) compared with radiosurgery group. Surgery patients also experienced more treatment-related complications than the radiation (28.5 versus 2.6%, p<0.0001) cohort.
CONCLUSIONS: Patients who eventually underwent surgery were reported by their providers to have higher morbidity before and after treatment.
STUDY DESIGN: Retrospective analysis of the MarketScan database.
SETTING: MarketScan database.
SUBJECTS AND METHODS: A study of morbidity in VS patients who underwent treatment between 2002 and 2012 was conducted. A detailed account of morbidity at multiple time points before and after treatment was described.
RESULTS: Of 3,355 patients treated for VS, 2,029 (60.5%) underwent surgery and 1,326 (39.5%) radiation. The average (SD) age of diagnosis was 52.5 (12.1) years. Patients were followed for a mean (SD) of 29.1 (24.2) months before and 39.2 (30.5) months after treatment. Hearing loss (65.4%), vertigo (28.0%), tinnitus (24.7%), and headache (15.2%) were the most documented symptoms at 6 months before treatment. At this juncture, higher rates of hearing loss (71.6 versus 58.6%, p < 0.0001), vertigo (32.3 versus 21.4%, p<0.0001), and tinnitus (26.9 versus 21.5%, p=0.0004) were reported for the surgery cohort. At 6 months posttreatment, surgery cohort were reported to have higher rates of hearing loss (OR 2.15, 95% CI: 1.82-2.52), vertigo (OR 1.56, 95% CI: 1.23-1.96), balance (OR 4.17, 95% CI: 3.03-5.56), facial weakness (OR 10.0, 95% CI: 6.67-14.29), headache (OR 1.56, 95% CI: 1.23-1.96), fatigue (OR 2.22, 95% CI: 1.19-4.17), and swallowing difficulties (OR 2.33, 95% CI: 1.43-3.70) compared with radiosurgery group. Surgery patients also experienced more treatment-related complications than the radiation (28.5 versus 2.6%, p<0.0001) cohort.
CONCLUSIONS: Patients who eventually underwent surgery were reported by their providers to have higher morbidity before and after treatment.