Comparison of balance outcomes according to treatment modality of vestibular schwannoma

Gaeun Kim, Timothy Hullar, Jae Hyun Seo

Research output: Contribution to journalReview article

Abstract

Objectives: We sought to compare balance outcomes according to treatment modality of vestibular schwannoma (VS) via a meta-analysis that divided measuring tools of balance outcomes into three categories based on type. Methods: A comprehensive review of the literature from January 1966 to September 2017 was performed, looking for studies about long-term balance outcomes after microsurgery (MS), radiotherapy (RT), or observation for VS. A comprehensive meta-analysis was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and Egger's regression. Results: Among 633 references, 34 were included in the meta-analysis. Perceived dizziness improvement rate was significantly higher in the MS group than in the RT group (odds ratio [OR]: 1.61; 95% confidence interval [CI]: 1.08 to 2.40; P <.05, I2 = 4.18], but no significant difference was observed between the two groups with regard to validated dizziness questionnaire score (standardized mean difference: 0.04; 95% CI: −0.36 to 0.44; P =.84, I2 = 69.61) or dizziness or disequilibrium-related symptom incidence rate (OR: 0.91; 95% CI: 0.50 to 1.68; P =.77, I2 = 0). In a subanalysis conducted within the groups after intervention, the MS group demonstrated a lower vertigo incidence rate (P <.001), and the RT group experienced a significant reduction in validated dizziness questionnaire score (P <.05). Conclusions: Our results indicate that MS should be considered at least equal to RT in regard to resolving long-term dizziness and improving balance outcomes. Furthermore, well-designed studies are necessary to predict balance outcomes after VS treatment and to choose from among possible treatment options. Level of Evidence: 2a Laryngoscope, 2019.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StatePublished - Jan 1 2019

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Acoustic Neuroma
Dizziness
Microsurgery
Radiotherapy
Meta-Analysis
Confidence Intervals
Odds Ratio
Laryngoscopes
Therapeutics
Publication Bias
Vertigo
Incidence
Observation

Keywords

  • balance
  • meta-analysis
  • microsurgery
  • radiotherapy
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Comparison of balance outcomes according to treatment modality of vestibular schwannoma. / Kim, Gaeun; Hullar, Timothy; Seo, Jae Hyun.

In: Laryngoscope, 01.01.2019.

Research output: Contribution to journalReview article

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abstract = "Objectives: We sought to compare balance outcomes according to treatment modality of vestibular schwannoma (VS) via a meta-analysis that divided measuring tools of balance outcomes into three categories based on type. Methods: A comprehensive review of the literature from January 1966 to September 2017 was performed, looking for studies about long-term balance outcomes after microsurgery (MS), radiotherapy (RT), or observation for VS. A comprehensive meta-analysis was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and Egger's regression. Results: Among 633 references, 34 were included in the meta-analysis. Perceived dizziness improvement rate was significantly higher in the MS group than in the RT group (odds ratio [OR]: 1.61; 95{\%} confidence interval [CI]: 1.08 to 2.40; P <.05, I2 = 4.18], but no significant difference was observed between the two groups with regard to validated dizziness questionnaire score (standardized mean difference: 0.04; 95{\%} CI: −0.36 to 0.44; P =.84, I2 = 69.61) or dizziness or disequilibrium-related symptom incidence rate (OR: 0.91; 95{\%} CI: 0.50 to 1.68; P =.77, I2 = 0). In a subanalysis conducted within the groups after intervention, the MS group demonstrated a lower vertigo incidence rate (P <.001), and the RT group experienced a significant reduction in validated dizziness questionnaire score (P <.05). Conclusions: Our results indicate that MS should be considered at least equal to RT in regard to resolving long-term dizziness and improving balance outcomes. Furthermore, well-designed studies are necessary to predict balance outcomes after VS treatment and to choose from among possible treatment options. Level of Evidence: 2a Laryngoscope, 2019.",
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