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Patient-perceived long-term communication and swallow function following cerebellopontine angle surgery

Authors

  • Heather M. Starmer MA, CCC-SLP,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland, U.S.A
    • Send correspondence to Heather M. Starmer M.A. CCC-SLP, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, 601 N. Caroline Street Suite 6260, Baltimore, MD 21287. E-mail: hstarme1@jhmi.edu

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  • Bryan K. Ward MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland, U.S.A
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  • Simon R.A. Best MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland, U.S.A
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  • Christine G. Gourin MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland, U.S.A
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  • Lee M. Akst MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland, U.S.A
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  • Alexander Hillel MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland, U.S.A
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  • Henry Brem MD,

    1. Department of Neurosurgery, Johns Hopkins Medical Institution, Baltimore, Maryland, U.S.A.
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  • Howard W. Francis MD

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland, U.S.A
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  • Presented at the Triological Society Meeting at COSM, Orlando, Florida, U.S.A., April 10–14 2013.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Evaluation of long-term patient-perceived functional outcomes and quality of life (QOL) related to communication and eating with an emphasis on voice, speech production, and swallowing after cerebello-pontine angle (CPA) surgery.

Study Design

Prospective cross-sectional study.

Methods

The MD Anderson Dysphagia Inventory (MDADI), Voice Handicap Index (VHI), and Facial Clinimetric Evaluation (FaCE) surveys were distributed to patients who underwent CPA surgery between January 2008 and December 2010. Immediate postoperative cranial nerve function extracted from medical records was compared to long-term patient-perceived function and associated QOL.

Results

There was a 61% response rate with a mean postoperative period of 31.6 months (range 15–49). The presence of facial palsy in the postoperative period and the corresponding House-Brackmann (H-B) score were the strongest predictors of patient-perceived long-term function and QOL in all three domains (P < .005). Postoperative vagal palsy by comparison was not associated with long-term disturbance of voice or speech function. Postoperative dysphagia had a particularly large association with perceived long-term facial function and related QOL (P < .0005), with a smaller but significant impact on perceived swallow outcome (P < .05). After adjusting for other variables, the postoperative H-B score remained a significant predictor of perceived long-term facial and voice function and related QOL.

Conclusions

Patients with severe facial dysfunction following surgery to the CPA are at increased risk for long-term self-reported difficulties with communication and eating, even with improvement of vagal function. Speech and swallow therapy should therefore be provided to these patients whether or not they also have pharyngeal dysphagia or voice disturbance.

Level of Evidence

2b. Laryngoscope, 124:476–480, 2014

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