Clinical Practice Guideline on the Management of Vestibular Schwannoma
Acta Otorrinolaringologica Espanola
Lassaletta, L., Acle Cervera, L., et al. (2024).
Acta Otorrinolaringologica Espanola, 75(2), 108-128.
<div>This clinical practice guideline provides recommendations regarding the clinical management of individuals with vestibular schwannoma. This article summary only reports recommendations relevant to the scope of audiology. </div>
Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (Spain)
<div>Intervention options for hearing loss following treatment for vestibular schwannoma include:</div>
<div>
<ul>
<li>contralateral routing of sound (CROS) or bilateral CROS (BiCROS) hearing aids;</li>
<li>bone conduction devices; </li>
<li>cochlear implants (CIs) for individuals with preserved cochlear nerve function; and</li>
<li>auditory brainstem implants for individuals with neurofibromatosis type 2 and resulting cochlear nerve injury (Level 4C Evidence).</li>
</ul>
</div>
<div>CIs may be indicated for the following individuals with vestibular schwannoma:</div>
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<ul>
<li>patients with neurofibromatosis type 2;</li>
<li>patients with sporadic vestibular schwannoma in one ear; and</li>
<li>patients with sporadic vestibular schwannoma and normal contralateral hearing (Level 4C Evidence).</li>
</ul>
</div>
<div>Hearing can be monitored during surgery for vestibular schwannoma in the following instances:</div>
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<ul>
<li><strong>In individuals for whom the goal is hearing preservation:</strong> Measurements can be made by means of brainstem auditory evoked potentials or by direct monitoring of the vestibulocochlear nerve.</li>
<li><strong>In evaluating potential for CIs during surgery with a translabyrinthine approach: </strong> Intraoperative evaluation of the cochlear nerve can be performed by electrical potentials (Level 5D Evidence). </li>
</ul>
</div>
<div>Individuals with instability following vestibular schwannoma surgery should:</div>
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<ul>
<li>be encouraged to move about early on following surgery and to not use vestibular sedatives (Level 4C Evidence);</li>
<li>be exposed to optokinetic stimuli and vestibulo-ocular reflex (VOR) exercises early in their recovery (Level 4C Evidence);</li>
<li>receive early vestibular rehabilitation (Level 3C Evidence); and</li>
<li>receive a comprehensive vestibular evaluation including an evaluation of tolerance to movement, gait, dynamic visual acuity, posturography, video head impulse testing, etc. to rule our cerebellar pathology and inform rehabilitation plan (Level 3C Evidence).</li>
</ul>
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<div>The following vestibular testing is recommended for individuals with vestibular schwannoma:</div>
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<ul>
<li>A vestibular study should be conducted prior to surgery to determine the baseline vestibular function will help to develop rehabilitation strategies (Level 4C Evidence).</li>
<li>The Video Head Impulse Test (VHIT), vestibular evoked myogenic potentials, and videonystagmography are useful both before and after surgery (Level 3C Evidence).</li>
<li>Posturography can be appropriate to assess the degree of pre- and post-operative compensation (Level 3C Evidence). </li>
</ul>
</div>
