Surgical removal of vestibular schwannoma causes acute vestibular symptoms, including postoperative vertigo and oscillopsia due to nystagmus. In general, the dominant symptom postoperatively is vertigo. Preoperative chemical vestibular ablation can reduce vestibular symptoms postoperatively. We used 1.0 mL of 40 mg/mL nonbuffered gentamicin in three intratympanic installations over 2 days, 2 months preoperatively in 10 patients. Reduction of vestibular function was measured by the head impulse test and the caloric test. Reduction of vestibular function was found in all gentamicin patient groups. After gentamicin vestibular ablation, patients underwent home vestibular exercising for two months. The control group consisted of 10 patients who underwent only home vestibular training two months preoperatively. Postoperative rates of recovery and vertigo in both groups were evaluated with the Glasgow Benefit Inventory (GBI), the Glasgow Health Status Inventory (GHSI), and the Dizziness Handicap Inventory questionnaires, as well as survey of visual symptoms by specific questionnaire developed by us. There were no statistically significant differences between both groups with regard to the results of questionnaires. Patients who received preoperative gentamicin were more resilient to optokinetic and optic flow stimulation (p < 0.05). This trial is registered with clinical study registration number NCT02963896.

Department of Anthropometrics and Methodology Faculty of Physical Education and Sport Charles University Prague Czech Republic

Department of Neurology 2nd Faculty of Medicine Charles University and Motol University Hospital Postgraduate Medical School Prague Czech Republic

Department of Otorhinolaryngology 3rd Faculty of Medicine University Hospital Kralovske Vinohrady Charles University Prague Czech Republic

Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine Charles University and Motol University Hospital Postgraduate Medical School Prague Czech Republic

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University and Motol University Hospital Postgraduate Medical School Prague Czech Republic

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Betka J., Zvěřina E., Balogová Z., et al. Complications of microsurgery of vestibular schwannoma. BioMed Research International. 2014;2014:10. doi: 10.1155/2014/315952.315952 PubMed DOI PMC

Betka J., Zvěřina E., Lisý J., Chovanec M., Kluh J., Kraus J. Vestibulární schwannom. Otorinolaryngologie a Foniatrie. 2008;57:221–225.

Herdman S. J., Clendaniel R. A., Mattox D. E., Holliday M. J., Niparko J. K. Vestibular adaptation exercises and recovery: acute stage after acoustic neuroma resection. Otolaryngology—Head and Neck Surgery. 1995;113(1):77–87. doi: 10.1016/s0194-5998(95)70148-6. PubMed DOI

Furman J. M., Balaban C. D., Pollack I. F. Vestibular compensation in a patient with a cerebellar infarction. Neurology. 1997;48(4):916–920. doi: 10.1212/WNL.48.4.916. PubMed DOI

Cohen H. S., Kimball K. T., Jenkins H. A. Factors affecting recovery after acoustic neuroma resection. Acta Oto-Laryngologica. 2002;122(8):841–850. doi: 10.1080/003655402/000028039. PubMed DOI

Čakrt O., Truc M., Kolář P., Jeřábek J. Vestibulární rehabilitace-principy rehabilitace pacientů s poruchou vestibulárního systému. Neurologie Pro Praxi. 2007;8(6):354–356.

Magnusson M., Kahlon B., Karlberg M., Lindberg S., Siesjö P. Preoperative vestibular ablation with gentamicin and vestibular ‘prehab’ enhance postoperative recovery after surgery for pontine angle tumours—first report. Acta Oto-Laryngologica. 2007;127(12):1236–1240. doi: 10.1080/00016480701663433. PubMed DOI

Robinson K., Gatehouse S., Browning G. G. Measuring patient benefit from otorhinolaryngological surgery and therapy. Annals of Otology, Rhinology and Laryngology. 1996;105(6):415–422. doi: 10.1177/000348949610500601. PubMed DOI

Jacobson G. P., Newman C. W. The development of the Dizziness Handicap Inventory. Archives of Otolaryngology—Head and Neck Surgery. 1990;116(4):424–427. doi: 10.1001/archotol.1990.01870040046011. PubMed DOI

Tjernström F., Fransson P.-A., Kahlon B., et al. Vestibular PREHAB and gentamicin before schwannoma surgery may improve long-term postural function. Journal of Neurology, Neurosurgery and Psychiatry. 2009;80(11):1254–1260. doi: 10.1136/jnnp.2008.170878. PubMed DOI

Lacour M., Bernard-Demanze L. Interaction between vestibular compensation mechanisms and vestibular rehabilitation therapy: 10 recommendations for optimal functional recovery. Frontiers in Neurology. 2015;5, article 285 doi: 10.3389/fneur.2014.00285. PubMed DOI PMC

Han B. I., Song H. S., Kim J. S. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. Journal of Clinical Neurology. 2011;7(4):184–196. doi: 10.3988/jcn.2011.7.4.184. PubMed DOI PMC

Mruzek M., Barin K., Nichols D. S., Burnett C. N., Welling D. B. Effects of vestibular rehabilitation and social reinforcement on recovery following ablative vestibular surgery. Laryngoscope. 1995;105(7):686–692. doi: 10.1288/00005537-199507000-00004. PubMed DOI

O'Connor K. W., Loughlin P. J., Redfern M. S., Sparto P. J. Postural adaptations to repeated optic flow stimulation in older adults. Gait and Posture. 2008;28(3):385–391. doi: 10.1016/j.gaitpost.2008.01.010. PubMed DOI PMC

Sundermier L., Woollacott M. H., Jensen J. L., Moore S. Postural sensitivity to visual flow in aging adults with and without balance problems. Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 1996;51(2):45–52. PubMed

Saman Y., Mclellan L., Mckenna L., et al. State anxiety subjective imbalance and handicap in vestibular schwannoma. Frontiers in Neurology. 2016;7, article 101 doi: 10.3389/fneur.2016.00101. PubMed DOI PMC

Cullen K. E., Minor L. B., Beraneck M., Sadeghi S. G. Neural substrates underlying vestibular compensation: contribution of peripheral versus central processing. Journal of Vestibular Research. 2009;19(5-6):171–182. doi: 10.3233/ves-2009-0357. PubMed DOI PMC

The comparison between intratympanic gentamicin prehabilitation and postoperative virtual reality exposure to standard vestibular training in patients with vestibular schwannoma

Does vestibular function correlate with objective MRI findings after vestibular schwannoma surgery?

Decision making on vestibular schwannoma treatment: predictions based on machine-learning analysis

The evaluation of vestibular compensation by vestibular rehabilitation and prehabilitation in short-term postsurgical period in patients following surgical treatment of vestibular schwannoma

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NCT02963896