OBJECTIVE: Resection of the vestibular schwannoma causes acute peripheral vestibular loss. The process of central compensation starts immediately afterward. The rehabilitation goal is to support this process and restore the quality of life. MATERIALS AND METHODS: In this prospective single-center study, 67 consecutive patients underwent vestibular schwannoma resection (40 females, mean age 52 ± 12 years). The patients were divided into three groups: the prehabilitation with intratympanic gentamicin group, the virtual reality group (optokinetic stimulation via virtual reality goggles in the first ten days after the surgery), and the control group. All patients were examined with objective methods and completed questionnaires before the prehabilitation, before the surgery, at the hospital discharge, and after three months. RESULTS: Intratympanic gentamicin prehabilitation leads ipsilaterally to a significant aVOR reduction in all semicircular canals (p < 0.050), the increase of the unilateral weakness in air calorics (p = 0.026), and loss of cVEMPs responses (p = 0.017). Prehabilitation and postoperative exposure to virtual reality scenes improved the patient's perception of vertigo problems according to Dizziness Handicap Inventory (p = 0.039 and p = 0.076, respectively). These findings conform with the optokinetic testing results, which showed higher slow phase velocities at higher speeds (40 deg/s) in both targeted groups compared to the control group. CONCLUSION: Preoperative intratympanic gentamicin positively affects peripheral vestibular function, influencing balance perception after VS resection. In long-term follow-up, prehabilitation and postoperative exposure to virtual reality improve patients' quality of life in the field of vertigo problems.

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

Department of Neurology 2nd Faculty of Medicine Charles University Motol University Hospital Prague Czech Republic

Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine Charles University Prague and Motol University Hospital 5 Úvalu 84 Prague 150 06 Czech Republic

Department of Otorhinolaryngology and Head and Neck Surgery Havířov Hospital Havířov Czech Republic

Department of Otorhinolaryngology The 2nd Faculty of Medicine Charles University University Hospital Motol Prague Czech Republic

Zobrazit více v PubMed

Propp JM, McCarthy BJ, Davis FG, Preston-Martin S (2006) Descriptive epidemiology of vestibular schwannomas. Neuro Oncol 8(1):1–11. 10.1215/S1522851704001097 PubMed PMC

Torres Maldonado S, Naples JG, Fathy R et al (2019) Recent trends in vestibular Schwannoma Management: an 11-Year analysis of the National Cancer Database. Otolaryngol - Head Neck Surg (United States) 161(1):137–143. 10.1177/0194599819835495 PubMed

Lui F, Foris L, Willner K, Tadi P (2017) Central Vertigo. J Int Comm Radiat Units Meas 14(2):1–160

Deveze A, Bernard-Demanze L, Xavier F, Lavieille JP, Elziere M Vestibular compensation and vestibular rehabilitation. Current concepts and new trends. Neurophysiol Clin 2014:49–57. 10.1016/j.neucli.2013.10.138 PubMed

Balatkova Z, Cerny R, Fik Z et al (2018) Faktory ovlivňující vestibulární kompenzaci u pacientů po operaci vestibulárního schwannomu. Otorinolaryngol Foniatr 4:91–94

Bonaventurova M, Cada Z, Koucky V et al Vestibular rehabilitation in patients after vestibular schwannoma surgery. Česká a Slovenská Neurologie a Neurochirurgie. 10.48095/cccsnn2023114

MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS (2009) The video head impulse test. Neurology 73(14):1134–1141. 10.1212/WNL.0B013E3181BACF85 PubMed PMC

Rosengren SM, Colebatch JG, Young AS, Govender S, Welgampola MS (2019) Vestibular evoked myogenic potentials in practice: methods, pitfalls and clinical applications. Clin Neurophysiol Pract 4:47–68. 10.1016/J.CNP.2019.01.005 PubMed PMC

Koos WT, Day JD, Matula C, Levy DI (1998) Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88(3):506–512. 10.3171/JNS.1998.88.3.0506 PubMed

McCaslin DL, Jacobson GP (2009) Current role of the videonystagmography examination in the context of the multidimensional balance function test battery. Semin Hear 30(4):242–252. 10.1055/S-0029-1241125/ID/16

Oussou G, Magnani C, Bargiotas I, Lamas G, Tankere F, Vidal C (2022) A New Sensitive Test using virtual reality and foam to probe postural control in vestibular patients: the unilateral Schwannoma Model. Front Neurol 13. 10.3389/FNEUR.2022.891232 PubMed PMC

West N, Sass H, Klokker M, Cayé-Thomasen P (2020) Video Head Impulse Test results in patients with a vestibular schwannoma-sensitivity and correlation with other vestibular system function tests, hearing acuity, and Tumor size. Otol Neurotol 41(5):e623–e629. 10.1097/MAO.0000000000002600 PubMed

Bell SL, Barker F, Heselton H, MacKenzie E, Dewhurst D, Sanderson A (2015) A study of the relationship between the video head impulse test and air calorics. Eur Arch Oto-Rhino-Laryngology 272(5):1287–1294. 10.1007/S00405-014-3397-4/TABLES/2 PubMed

Millar JL, Gimmon Y, Roberts D, Schubert MC (2020) Improvement after vestibular Rehabilitation not explained by Improved Passive VOR Gain. Front Neurol 11:79. 10.3389/FNEUR.2020.00079/BIBTEX PubMed PMC

Macfarlan D (1942) Hearing aids accepted by the council on physical therapy, American medical association. Arch Otolaryngol 36(2):240–242. 10.1001/ARCHOTOL.1942.03760020076011

Shaffer BT, Cohen MS, Bigelow DC, Ruckenstein MJ (2010) Validation of a disease-specific quality-of-life instrument for acoustic neuroma. Laryngoscope 120(8):1646–1654. 10.1002/LARY.20988 PubMed

Jacobson GP, Newman CW (1990) The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 116(4):424–427. 10.1001/ARCHOTOL.1990.01870040046011 PubMed

Spitzer RL, Kroenke K, Williams JBW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097. 10.1001/ARCHINTE.166.10.1092 PubMed

Zung WWK (1965) A self-rating depression scale. Arch Gen Psychiatry 12(1):63–70. 10.1001/ARCHPSYC.1965.01720310065008 PubMed

Čada Z, Balatková Z, Chovanec M et al (2016) Vertigo Perception and Quality of Life in patients after Surgical treatment of vestibular schwannoma with pretreatment prehabituation by Chemical vestibular ablation. Biomed Res Int 2016. 10.1155/2016/6767216 PubMed PMC

White IR, Royston P, Wood AM (2011) Multiple imputation using chained equations: issues and guidance for practice. Stat Med 30(4):377–399. 10.1002/SIM.4067 PubMed

Graham JW, Olchowski AE, Gilreath TD (2007) How many imputations are really needed? Some practical clarifications of multiple imputation theory. Prev Sci 8(3):206–213. 10.1007/S11121-007-0070-9/METRICS PubMed

Berry KJ, Mielke PW (2000) Exact and Monte Carlo resampling procedures for the wilcoxon-Mann-Whitney and Kruskal-Wallis tests. Percept Mot Skills 91(3):749–754. 10.2466/PMS.2000.91.3.749 PubMed

Cohen-Kerem R, Kisilevsky V, Einarson TR, Kozer E, Koren G, Rutka JA (2004) Intratympanic gentamicin for Meniere’s disease: a meta‐analysis. Laryngoscope 114(12):2085–2091. 10.1097/01.mlg.0000149439.43478.24 PubMed

Plontke SK, Mynatt R, Gill RM, Borgmann S, Salt A (2007) N. Concentration gradient along the scala tympani after local application of gentamicin to the round window membrane. Laryngoscope 117(7):1191–1198. 10.1097/MLG.0b013e318058a06b PubMed PMC

Salt AN, Plontke S (2018) K.Pharmacokinetic principles in the inner ear: influence of drug properties on intratympanic applications. Hear Res 368:28–40. 10.1016/j.heares.2018.03.002 PubMed PMC

Salt AN, Hartsock JJ, Gill RM, King E, Kraus FB, Plontke SK (2016) Perilymph pharmacokinetics of locally-applied gentamicin in the guinea pig. Hear Res 342:101–111. 10.1016/j.heares.2016.10.003 PubMed PMC

Van Gompel JJ, Agazzi S, Carlson ML et al (2018) Congress of Neurological Surgeons Systematic Review and evidence-based guidelines on emerging therapies for the treatment of patients with Vestibular Schwannomas. 82:E52–E54Clinical Neurosurgery PubMed

Tarnutzer AA, Bockisch CJ, Buffone E, Huber AM, Wettstein VG, Weber KP (2021) Pre-habilitation before vestibular schwannoma surgery—impact of Intratympanal Gentamicin Application on the Vestibulo-Ocular Reflex. Front Neurol 12:22. 10.3389/fneur.2021.633356 PubMed PMC

Tarnutzer AA, Bockisch CJ, Buffone E, Weiler S, Bachmann LM, Weber KP (2016) Disease-specific sparing of the anterior semicircular canals in bilateral vestibulopathy. Clin Neurophysiol 127(8):2791–2801. 10.1016/J.CLINPH.2016.05.005 PubMed

Potdar T, Kontorinis G (2023) Pre-habilitation with intratympanic gentamicin in vestibular schwannomas: a systematic review. J Laryngol Otol 137(9):985–991. 10.1017/S0022215123000725 PubMed

Fuentealba Bassaletti C, van Esch BF, Jansen JC, van Benthem PPG, Hensen EF (2023) The effect of intratympanic gentamicin as a prehabilitation strategy for objective and subjective vestibular function in patients undergoing microsurgery for a unilateral vestibular schwannoma. Eur Arch Oto-Rhino-Laryngology 012345678910.1007/s00405-023-08240-1 PubMed PMC

Yetişer S (2018) Intratympanic gentamicin for intractable Meniere’s Disease–a review and analysis of audiovestibular impact. Int Archives Otorhinolaryngol 22(02):190–194. 10.1055/s-0037-1604064 PubMed PMC

Brown KE, Whitney SL, Wrisley DM, Furman JM (2001) Physical therapy outcomes for persons with bilateral vestibular loss. Laryngoscope 111(10):1812–1817. 10.1097/00005537-200110000-00027 PubMed

Abboud T, Regelsberger J, Matschke J, Jowett N, Westphal M, Dalchow C (2016) Long-term vestibulocochlear functional outcome following retro-sigmoid approach to resection of vestibular schwannoma. Eur Arch Otorhinolaryngol 273(3):719–725. 10.1007/S00405-015-3561-5 PubMed

Pavlou M, Lingeswaran A, Davies RA, Gresty MA, Bronstein AM (2004) Original communication. Simulator-based rehabilitation in refractory dizziness. J Neurol 251:983–995. 10.1007/s00415-004-0476-2 PubMed

Redfern MS, Furman JM (1994) Postural sway of patients with vestibular disorders during optic flow. J Vestib Res 4(3):221–230 PubMed

Bronstein AM (1995) Visual vertigo syndrome: clinical and posturography findings. J Neurol Neurosurg Psychiatry 59(5):472–476. 10.1136/JNNP.59.5.472 PubMed PMC

Guerraz M, Yardley L, Bertholon P et al (2001) Visual vertigo: symptom assessment, spatial orientation, and postural control. Brain 124(Pt 8):1646–1656. 10.1093/BRAIN/124.8.1646 PubMed

Pavlou M, Kanegaonkar RG, Swapp D, Bamiou DE, Slater M, Luxon LM (2012) The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study. J Vestib Res Equilib Orientat 22(5–6):273–281. 10.3233/VES-120462 PubMed

Choi SY, Choi JH, Oh EH, Oh SJ, Choi KD (2021) Effect of vestibular exercise and optokinetic stimulation using virtual reality in persistent postural-perceptual dizziness. Sci Rep 11(1). 10.1038/S41598-021-93940-Z PubMed PMC

Nehrujee A, Vasanthan L, Lepcha A, Balasubramanian S (2019) A smartphone-based gaming system for vestibular rehabilitation: a usability study. J Vestib Res 29(2–3):147–160. 10.3233/VES-190660 PubMed

Heffernan A, Booth L, Fletcher R, Nunez DA (2023) Vestibular rehabilitation potential of commercially available virtual reality video games. J Otolaryngol Head Neck Surg 52(1):54. 10.1186/S40463-023-00642-9/TABLES/3 PubMed PMC

Bergeron M, Lortie CL, Guitton MJ (2015) Use of virtual reality tools for vestibular disorders Rehabilitation: a comprehensive analysis. Adv Med 2015:1–9. 10.1155/2015/916735 PubMed PMC

Lacour M Restoration of vestibular function: Basic aspects and practical advances for rehabilitation. Curr Med Res Opin 2006:1651–1659. 10.1185/030079906X115694 PubMed

Whitney SL, Sparto PJ, Furman JM (2020) Vestibular Rehabilitation and factors that can affect outcome. Semin Neurol 40(1):165–172. 10.1055/S-0039-3402062 PubMed

Zobeiri OA, Mischler GM, King SA, Lewis RF, Cullen KE (2021) Effects of vestibular neurectomy and neural compensation on head movements in patients undergoing vestibular schwannoma resection. Sci Rep 11(1). 10.1038/S41598-020-79756-3 PubMed PMC

Paul SS, Dibble LE, Walther RG, Shelton C, Gurgel RK, Lester ME (2018) Reduced Purposeful Head Movements during Community Ambulation following unilateral vestibular loss. Neurorehabil Neural Repair 32(4–5):309–316. 10.1177/1545968318770271 PubMed

Van Laer L, Hallemans A, Van Rompaey V, De Valck C, Van de Heyning P, Vereeck L (2022) Subjective perception of activity level: a prognostic factor for developing chronic dizziness after vestibular schwannoma resection? Front Neurol 13. 10.3389/FNEUR.2022.925801 PubMed PMC