1
|
Nowacka A, Barker-Collo S, Miles A. Exploring the influence of appearance evaluation apprehension: How fear of negative evaluation affects quality of life in people with Vestibular Schwannoma. J Clin Neurosci 2024; 123:7-12. [PMID: 38508019 DOI: 10.1016/j.jocn.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
People diagnosed with Vestibular Schwannoma (VS) can experience several symptoms both pre and post-treatment. These, alongside the diagnosis experience, can significantly impact their daily life. The present research is a continuation of a larger study aiming to explore the impacts of symptomology and body image/fear of negative evaluation (FNAE) on the quality of life (QOL) for people with VS. The research design was exploratory and involved a nationwide survey with a total of 52 participants. FNAE was assessed using a measurement of the same name, and QOL was assessed using the Penn Acoustic Neuroma Quality of Life scale (PANQOL). Comparing management groups revealed a significant difference in FNAE with higher scores for surgery compared to radiation treatment. Regression analyses revealed that FNAE significantly accounted for 10.9% of the variance in QOL. However, no symptom was significantly predictive of FNAE. In conclusion, VS is associated with several symptoms that can persist post-treatment. Body satisfaction contributes to QOL and may differ between management types. However, due to inconclusive findings on the predictability of symptoms on FNAE, other moderator factors could influence these direct relationships. Future studies should evaluate the variables that could mitigate or protect from the impacts of FNAE for this population.
Collapse
Affiliation(s)
- Alicja Nowacka
- School of Psychology, The University of Auckland, Auckland, New Zealand.
| | - Suzanne Barker-Collo
- Clinical Training Programme, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
Nowacka A, Barker-Collo S, Miles A, Ben-Harosh L. The effect of symptomatology and mental wellbeing on quality of life in people with acoustic neuroma. J Clin Neurosci 2023; 116:1-7. [PMID: 37597328 DOI: 10.1016/j.jocn.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Acoustic neuroma (AN) research largely employs a medical framework to understand health outcomes. An alternative is to examine quality of life (QOL) outcomes. This study explored whether mental well-being (i.e., anxiety and depression) were predictive of QOL in those with AN over and above symptomatology. METHODS A nationwide online survey was distributed to 24 community organisations. The inclusion criteria were a diagnosis of AN irrespective of the treatment approach. There were 52 respondents. Mental well-being was assessed using the Hospital Anxiety and Depression Scale (HADS), and quality of life was assessed using Penn Acoustic Neuroma QOL scale (PANQOL). RESULTS The most frequently reported symptoms reported were poor balance, tinnitus, hearing loss, and headache. Preliminary analyses suggested that headaches, tinnitus and mental well-being were significantly correlated with QOL. Hierarchical regression revealed that these two symptoms and mental well-being accounted for 18.7% and 51.1% of the variance in QOL, respectively. In addition, there was a significant difference in depression scores between management types, with the surgery group having a significantly higher depression score than the radiation group. CONCLUSION Symptoms and mood contribute to QOL for those diagnosed with AN. This can be understood through the common-sense model and fear of cancer recurrence. Screening for psychological difficulties should be provided from the point of diagnosis to post-treatment to allow for targeted management plans to mitigate the effects of these on QOL.
Collapse
Affiliation(s)
- Alicja Nowacka
- School of Psychology, The University of Auckland, Auckland, New Zealand.
| | - Suzanne Barker-Collo
- Clinical Training Programme, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Lior Ben-Harosh
- School of Psychology, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
3
|
La Monte OA, Moshtaghi O, Tang E, Du EY, Swisher AR, Dixon PR, Nemati S, Djalilian HR, Schwartz MS, Friedman RA. Use of a Novel Clinical Decision-Making Tool in Vestibular Schwannoma Treatment. Otol Neurotol 2022; 43:e1174-e1179. [PMID: 36240736 DOI: 10.1097/mao.0000000000003719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the usefulness of a personalized tool and its effect on the decision-making process for those with vestibular schwannoma (VS). STUDY DESIGN Prospective study. SETTING Single institution, academic tertiary care lateral skull base surgery program. PATIENTS Patients diagnosed with VS. INTERVENTIONS A comprehensive clinical decision support (CDS) tool was constructed from a previously published retrospective patient-reported data obtained from members of the Acoustic Neuroma Association from January to March 2017. Demographic, tumor, and treatment modality data, including associated side effects, were collected for 775 patients and integrated in an interactive and personalized web-based tool. MAIN OUTCOME MEASURES Pre- and posttool questionnaires assessing the process of deciding treatment for VS using a decisional conflict scale (DCS) and satisfaction with decision (SWD) scale were compared. RESULTS A pilot study of 33 patients evaluated at a single institution tertiary care center with mean ± SD age of 63.9 ± 13.5 years and with average tumor size of 7.11 ± 4.75 mm were surveyed. CDS implementation resulted in a mean ± SD total DCS score decrease from 43.6 ± 15.5 to 37.6 ± 16.4 ( p < 0.01) and total SWD score increase from 82.8 ± 16.1 to 86.2 ± 14.4 ( p = 0.04), indicating a significant decrease in decisional conflict and increase in satisfaction. CONCLUSIONS Implementing a decision-making tool after diagnosis of VS reduced decisional conflict and improved satisfaction with decision. Patients considered the tool to be an aid to their medical knowledge, further improving their comfort and understanding of their treatment options. These findings provide a basis for developing predictive tools that will assist patients in making informed medical decisions in the future.
Collapse
Affiliation(s)
| | - Omid Moshtaghi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla
| | - Edison Tang
- School of Medicine, University of California, San Diego, La Jolla
| | - Eric Y Du
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla
| | - Austin R Swisher
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla
| | - Peter R Dixon
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla
| | - Shamim Nemati
- School of Medicine, University of California, San Diego, La Jolla
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine
| | - Marc S Schwartz
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Rick A Friedman
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla
| |
Collapse
|
4
|
Impact of Demographics and Clinical Features on Initial Treatment Pathway for Vestibular Schwannoma. Otol Neurotol 2022; 43:1078-1084. [PMID: 35960883 PMCID: PMC9878333 DOI: 10.1097/mao.0000000000003652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To identify demographic and clinical features impacting initial treatment pathway for vestibular schwannoma. STUDY DESIGN Retrospective chart review. SETTING Tertiary care academic medical center. PATIENTS Patients diagnosed with vestibular schwannoma between 2009 and 2019. INTERVENTIONS Observation, stereotactic radiosurgery, or microsurgical resection. MAIN OUTCOME MEASURES χ 2 Test, one-way analysis of variance, and multivariate logistic regression were used to correlate demographic and clinical factors with initial treatment pathway for 197 newly diagnosed vestibular schwannoma patients. RESULTS Among 197 patients, 93 (47%) were initially treated with observation, 60 (30%) with stereotactic radiation (Gamma Knife) and 44 (22%) with surgical resection. Age univariately had no statistically significant impact on initial pathway, but those undergoing surgery trended toward a younger demographic (49.1 yr [surgery] versus 57.2 yr [observation] versus 59.0 yr [Gamma Knife]). Men were more likely to be initially observed than women ( p = 0.04). Patients initially observed were more likely to have a lower Koos classification ( p < 0.001) and have better tumor-ear hearing ( p = 0.03). Only 34.4% of patients living outside the local geographic region were initially observed compared with 53.0% living locally ( p = 0.055). Surgeon correlated with initial treatment ( p = 0.04) but did not maintain significance when adjusting for hearing level or tumor size. A multiple linear regression model found age, maximum tumor diameter, and Koos class to correlate with initial treatment pathway ( p < 0.0001, r2 = 0.42). CONCLUSION Initial treatment pathway for newly diagnosed vestibular schwannoma is impacted by demographic factors such as age, sex, and geographic proximity to the medical center. Clinical features including hearing level and tumor size also correlated with initial treatment modality.
Collapse
|
5
|
Sergi B, Balducci M, Paludetti G, Olivi A, Picciotti PM, De Corso E, Passali GC, Fetoni AR, Lucidi D. Decision Making on Vestibular Schwannoma: Lessons from a Multidisciplinary Board. World Neurosurg 2021; 157:e506-e513. [PMID: 34710576 DOI: 10.1016/j.wneu.2021.10.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or radiosurgery, microsurgical resection, or wait and scan (WS). We describe the experience of our VS multidisciplinary team (MDT) at a tertiary university referral center created for diagnosis, treatment, and follow-up of VS patients. METHODS We conducted a retrospective study on 132 consecutive patients referred to the MDT and managed by observation (WS), microsurgery, or fractionated sRT. The analysis included patient age, tumor size, hearing level, facial nerve function, tumor control, complications, and quality of life questionnaires. RESULTS Among the patients, 21% were subjected to microsurgery, 10% to sRT, and 69% to WS. The median follow-up time was 30 months. Outcomes based on different management modalities are described. Statistically significant differences among groups were detected in terms of quality of life (physical domain). CONCLUSIONS MDT may provide the best individualized therapy for VS patients compared with a single gold-standard strategy.
Collapse
Affiliation(s)
- Bruno Sergi
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy; Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Mario Balducci
- Department of Radiotherapy, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Gaetano Paludetti
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy; Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Pasqualina Maria Picciotti
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy; Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy.
| | - Eugenio De Corso
- Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Giulio Cesare Passali
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy; Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Anna Rita Fetoni
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy; Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| |
Collapse
|
6
|
Patro A, Totten DJ, Sherry AD, Manzoor NF, Cass ND, Tawfik K, Bennett ML, O'Malley MR, Haynes DS, Perkins EL. Outcomes of Initial Observation Versus Upfront Microsurgical Resection for Small to Medium-sized Vestibular Schwannomas. Otol Neurotol 2021; 42:1408-1413. [PMID: 34149031 DOI: 10.1097/mao.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess postoperative outcomes and predictive factors of patients observed prior to microsurgery and those undergoing upfront resection for small and medium-sized VS. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS VS patients who had microsurgery from 2003 to 2018 for tumors up to 2.5 cm. MAIN OUTCOME MEASURES Postoperative outcomes including facial nerve function and interventions, complications, extent of resection, and salvage therapy. RESULTS Of 220 patients, 120 were initially observed, and 100 pursued upfront microsurgery. There was no significant association between initial observation and upfront microsurgery for postoperative facial nerve function at 2 to 3 weeks (p = 0.18) or 12 months (p = 0.5), facial nerve intervention (p = 0.5), major/minor complications (p = 0.48/0.63), recurrence (p = 0.8), subtotal resection (p = 0.6), or salvage therapy (p = 0.9). Time from initial consultation to surgery did not significantly impact outcomes. Intrameatal tumors were more likely to be observed (odds ratios [OR] 2.93; 95% CI 1.53-5.63; p = 0.001). Patients with larger tumor volume (OR 0.52; 95% CI 0.37-0.72; p < 0.0001), brainstem compression (OR 0.28; 95% CI 0.09-0.91; p = 0.03), or higher PTA were less likely to undergo observation (OR 0.99; 95% CI 0.97-0.997; p = 0.02). On multivariable analysis, predictive factors for observation were smaller tumor volume (OR 0.53; 95% CI 0.38-0.75; p < 0.001), lower PTA (OR 0.99; 95% CI 0.98-0.999; p = 0.04), and diabetes (OR 2.54; 95% CI 0.95-6.83; p = 0.06). CONCLUSIONS Patients with worse hearing, larger tumor volume, and brainstem compression were more likely to pursue upfront microsurgery. A watchful waiting period does not appear to worsen outcomes and can be considered for patients with better hearing and smaller tumors without brainstem compression.
Collapse
Affiliation(s)
- Ankita Patro
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | | | | | - Nauman F Manzoor
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals, ENT Institute, Case Western Reserve University, Cleveland, Ohio
| | - Nathan D Cass
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Kareem Tawfik
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Marc L Bennett
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Matthew R O'Malley
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - David S Haynes
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Elizabeth L Perkins
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| |
Collapse
|
7
|
Bader ER, Boyke A, Alvi MA, Sethi A, Funari A, Agarwal V. Medical Malpractice and Vestibular Schwannomas: A Nationwide Review. World Neurosurg 2021; 150:e714-e726. [PMID: 33775868 DOI: 10.1016/j.wneu.2021.03.093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most surgeons face litigation related to the care of their patients, with specialties including neurosurgery facing a particularly high risk. Diagnosis and management of vestibular schwannomas can be challenging, potentially giving rise to medicolegal proceedings. Accordingly, a full appreciation of the medicolegal implications of treating these challenging tumors is warranted. METHODS A systematic search of the Westlaw Edge legal database was conducted to identify all cases of medicolegal proceedings related to the management of vestibular schwannomas. All cases identified by the search were screened in full, and relevant cases included for analysis. Variables pertaining to the nature of the case and legal outcomes were extracted. RESULTS A total of 38 cases were included in this analysis from 11 U.S. states. Failure to diagnose and negligent surgery were the most common allegations. Neurosurgeons were the most frequently implicated specialists followed by otolaryngologists and radiologists. A verdict was reached in 30 cases, with the jury finding in favor of the defendant(s) in most cases (n = 26, 87.0%), a proportion that increased across each decade of the study period. Damages were paid out in 11 cases, with a mean value of $1,534,446. Mean value of damages paid in verdicts in favor of the plaintiff were larger than those in settlements ($2,116,543 and $1,385,457, respectively). CONCLUSIONS The data presented provide a comprehensive overview of medicolegal proceedings related to the management of vestibular schwannomas. This study provides clinicians with a greater appreciation of the medicolegal implications of treating vestibular schwannomas.
Collapse
Affiliation(s)
- Edward R Bader
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA.
| | - Andre Boyke
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Mohammed A Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Atharv Sethi
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Abigail Funari
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Vijay Agarwal
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
8
|
Shared decision-making in neurosurgery: a scoping review. Acta Neurochir (Wien) 2021; 163:2371-2382. [PMID: 33942189 PMCID: PMC8357744 DOI: 10.1007/s00701-021-04867-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/26/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In modern neurosurgery, there are often several treatment alternatives, with different risks and benefits. Shared decision-making (SDM) has gained interest during the last decade, although SDM in the neurosurgical field is not widely studied. Therefore, the aim of this scoping review was to present the current landscape of SDM in neurosurgery. METHODS A literature review was carried out in PubMed and Scopus. We used a search strategy based on keywords used in existing literature on SDM in neurosurgery. Full-text, peer-reviewed articles published from 2000 up to the search date February 16, 2021, with patients 18 years and older were included if articles evaluated SDM in neurosurgery from the patient's perspective. RESULTS We identified 22 articles whereof 7 covered vestibular schwannomas, 7 covered spinal surgery, and 4 covered gliomas. The other topics were brain metastases, benign brain lesions, Parkinson's disease and evaluation of neurosurgical care. Different methods were used, with majority using forms, questionnaires, or interviews. Effects of SDM interventions were studied in 6 articles; the remaining articles explored factors influencing patients' decisions or discussed SDM aids. CONCLUSION SDM is a tool to involve patients in the decision-making process and considers patients' preferences and what the patients find important. This scoping review illustrates the relative lack of SDM in the neurosurgical literature. Even though results indicate potential benefit of SDM, the extent of influence on treatment, outcome, and patient's satisfaction is still unknown. Finally, the use of decision aids may be a meaningful contribution to the SDM process.
Collapse
|
9
|
Patient-reported factors that influence the vestibular schwannoma treatment decision: a qualitative study. Eur Arch Otorhinolaryngol 2020; 278:3237-3244. [PMID: 33026499 PMCID: PMC8328891 DOI: 10.1007/s00405-020-06401-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/23/2020] [Indexed: 12/02/2022]
Abstract
Purpose In cases of small- to medium-sized vestibular schwannomas, three management strategies can be opted for: active surveillance, surgery or radiotherapy. In these cases, the patient’s preference is pivotal in decision-making. The aim of this study was to identify factors that influence a patient’s decision for a particular management strategy. Methods A qualitative inductive thematic analysis was performed based on semi-structured interviews. Eighteen patients with small- to medium-sized vestibular schwannomas were interviewed. All patients were diagnosed or treated at one of the two participating university medical centers in the Netherlands.
Results Ten themes were identified that influenced the decision, classified as either medical or patient-related. The medical themes that emerged were: tumor characteristics, the physician’s recommendation, treatment outcomes and the perceived center’s experience. The patient-related themes were: personal characteristics, anxiety, experiences, cognitions, logistics and trust in the physician.
Conclusion Knowledge of the factors that influence decision-making helps physicians to tailor their consultations to arrive at a true shared decision on vestibular schwannoma management.
Collapse
|
10
|
Wang X, Sun N, Meng X, Chen M, Jiang C, Cai J. Review of clinical nerve repair strategies for neurorestoration of central nervous system tumor damage. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Central nervous system (CNS) tumors are common. In recent years, with the continuous development and popularization of neurosurgery and the advancement of diagnostic and therapeutic instruments, the diagnosis and treatment of diseases have made great progress, but the prognosis of patients depends on multiple clinical factors. In this study, we selected various literatures in the PubMed and Google Scholar search engines using the keywords "nerve repair strategies" , "central nervous system tumor" as well as searched scientifically reviewed historical perspectives and recent advancements and achievements in Neurorestoratology of the CNS. Therefore, this study focuses on the Neurorestoratology of the CNS and its prospects, aiming to provide scientific guidance for the clinical diagnosis and treatment of CNS tumors in the future, and improve the prognosis and quality of life of patients.
Collapse
|
11
|
Patient quality of life after vestibular schwannoma removal: possibilities and limits to measuring different domains of patients' wellbeing. Eur Arch Otorhinolaryngol 2019; 276:2441-2447. [DOI: 10.1007/s00405-019-05499-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
|
12
|
Titze IR, Riede T, Palaparthi A, Hynan LS, Hamilton A, Toles L, Mau T. Individualized Patient Vocal Priorities for Tailored Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:2884-2894. [PMID: 30515514 PMCID: PMC6440314 DOI: 10.1044/2018_jslhr-s-18-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/23/2018] [Indexed: 05/04/2023]
Abstract
PURPOSE The purposes of this study are to introduce the concept of vocal priorities based on acoustic correlates, to develop an instrument to determine these vocal priorities, and to analyze the pattern of vocal priorities in patients with voice disorders. METHOD Questions probing the importance of 5 vocal attributes (vocal clarity, loudness, mean speaking pitch, pitch range, vocal endurance) were generated from consensus conference involving speech-language pathologists, laryngologists, and voice scientists, as well as patient feedback. The responses to the preliminary items from 213 subjects were subjected to exploratory factor analysis, which confirmed 4 of the predefined domains. The final instrument consisted of a 16-item Vocal Priority Questionnaire probing the relative importance of clarity, loudness, mean speaking pitch, and pitch range. RESULTS The Vocal Priority Questionnaire had high reliability (Cronbach's α = .824) and good construct validity. A majority of the cohort (61%) ranked vocal clarity as their highest vocal priority, and 20%, 12%, and 7% ranked loudness, mean speaking pitch, and pitch range, respectively, as their highest priority. The frequencies of the highest ranked priorities did not differ by voice diagnosis or by sex. Considerable individual variation in vocal priorities existed within these large trends. CONCLUSIONS A patient's vocal priorities can be identified and taken into consideration in planning behavioral or surgical intervention for a voice disorder. Inclusion of vocal priorities in treatment planning empowers the patient in shared decision making, helps the clinician tailor treatment, and may also improve therapy compliance.
Collapse
Affiliation(s)
- Ingo R. Titze
- National Center for Voice and Speech, University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Tobias Riede
- Department of Physiology, Midwestern University, Glendale, AZ
| | - Anil Palaparthi
- National Center for Voice and Speech, University of Utah, Salt Lake City
| | - Linda S. Hynan
- Departments of Clinical Sciences and Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | - Amy Hamilton
- Clinical Center for Voice Care, Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Laura Toles
- Clinical Center for Voice Care, Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas
- MGH Institute of Health Professions, Center for Laryngeal Surgery and Voice Rehabilitation, Boston, MA
| | - Ted Mau
- Clinical Center for Voice Care, Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
13
|
Hearing Outcomes in Conservatively Managed Vestibular Schwannoma Patients With Serviceable Hearing. Otol Neurotol 2018; 39:e704-e711. [DOI: 10.1097/mao.0000000000001914] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Abstract
Acoustic neuromas, also known as vestibular schwannomas, are slow-growing, benign tumors that develop on the eighth cranial nerve. Common signs and symptoms of an acoustic neuroma include hearing loss and balance disturbances. A physical examination, a hearing evaluation, and diagnostic imaging assist in the diagnosis of an acoustic neuroma. Patients with a confirmed tumor have three treatment options: observation, stereotactic radiosurgery, and surgical removal. Complications include cerebrospinal fluid leakage, damage to ancillary brain structures, facial nerve damage, and bleeding or vascular injury. This article focuses on the surgical removal of an acoustic neuroma and the role of the perioperative nurse in the perioperative care of the patient.
Collapse
|
15
|
Carlson ML, Tveiten ØV, Lund-Johansen M, Tombers NM, Lohse CM, Link MJ. Patient Motivation and Long-Term Satisfaction with Treatment Choice in Vestibular Schwannoma. World Neurosurg 2018; 114:e1245-e1252. [PMID: 29625305 DOI: 10.1016/j.wneu.2018.03.182] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To ascertain primary motivation and long-term satisfaction with treatment selection in patients with vestibular schwannoma. METHODS A multicenter, cross-sectional survey was performed. Patients with small- to medium-sized sporadic vestibular schwannoma who underwent stereotactic radiosurgery (SRS; n = 247), microsurgery (n = 144), or observation (n = 148) between 1998 and 2008 were surveyed regarding their motivation behind treatment selection and hindsight satisfaction with their choice of management. RESULTS "Physician recommendation" was the most commonly stated reason for modality selection in all 3 groups. The second and third most common reasons for selecting SRS included "less invasive option than surgery" in 80 patients (32%) and "less recovery time than surgery" in 16 patients (6%). The second and third most common reasons for selecting observation included "to avoid side-effects of treatment" in 25 patients (17%) and "symptoms not severe enough to warrant intervention" in 22 patients (15%). The second and third most common reasons for selecting microsurgery included "do not want tumor in head" in 35 patients (24%) and "most definitive treatment" in 15 patients (10%). Overall, 232 patients (96%) treated with SRS, 141 observed patients (97%), and 121 patients (85%) who underwent microsurgical treatment were satisfied with their original decision (P < 0.001). CONCLUSIONS Motivation behind treatment selection varies between individuals. Those who select observation and SRS commonly reference less invasiveness and lower risk, whereas those who select microsurgery are commonly motivated by having their tumor physically removed and the more definitive nature of treatment. Posttreatment satisfaction is highest in patients who undergo SRS and observation, although all 3 groups report high levels of satisfaction.
Collapse
Affiliation(s)
- Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| | - Øystein Vesterli Tveiten
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Morten Lund-Johansen
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Nicole M Tombers
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| |
Collapse
|