Decision making on the treatment of vestibular schwannoma (VS) is mainly based on the symptoms, tumor size, patient's preference, and experience of the medical team. Here we provide objective tools to support the decision process by answering two questions: can a single checkup predict the need of active treatment?, and which attributes of VS development are important in decision making on active treatment? Using a machine-learning analysis of medical records of 93 patients, the objectives were addressed using two classification tasks: a time-independent case-based reasoning (CBR), where each medical record was treated as independent, and a personalized dynamic analysis (PDA), during which we analyzed the individual development of each patient's state in time. Using the CBR method we found that Koos classification of tumor size, speech reception threshold, and pure tone audiometry, collectively predict the need for active treatment with approximately 90% accuracy; in the PDA task, only the increase of Koos classification and VS size were sufficient. Our results indicate that VS treatment may be reliably predicted using only a small set of basic parameters, even without the knowledge of individual development, which may help to simplify VS treatment strategies, reduce the number of examinations, and increase cause effectiveness.

• MeSH
• dospělí MeSH
• klinické rozhodování * MeSH
• lidé středního věku MeSH
• lidé MeSH
• management nemoci * MeSH
• reprodukovatelnost výsledků MeSH
• řízené strojové učení MeSH
• ROC křivka MeSH
• rozhodovací stromy MeSH
• senioři MeSH
• sluch MeSH
• sluchové testy MeSH
• strojové učení * MeSH
• určení symptomu MeSH
• vestibulární schwannom diagnóza   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Fischer 344 (F344) rats represent a strain that is frequently used as a model for fast aging. In this study, we systematically compare the hearing function during aging in male and female F344 rats, by recording auditory brainstem responses (ABRs) and distortion product otoacoustic emissions (DPOAEs). In addition to this, the functional parameters are correlated with the cochlear histology. The parameters of the hearing function were not different in the young (3-month-old) male and female F344 rats; the gender differences occurred only in adult and aged animals. In 8-24-month-old males, the ABR thresholds were higher and the ABR amplitudes were smaller than those measured in females of the same age. There were no gender differences in the neural adaptation tested by recording ABRs, elicited by a series of clicks with varying inter-click interval (ICI). Amplitudes of DPOAEs in both the males and females decreased with age, but in the males, the decrease of DPOAE amplitudes was faster. In males older than 20 months, the DPOAEs were practically absent, whereas in 20-24-month-old females, the DPOAEs were still measurable. There were no gender differences in the number of surviving outer hair cells (OHC) and the number of inner hair cell ribbon synapses in aged animals. The main difference was found in the stria vascularis (SV). Whereas the SV was well preserved in females up to the age of 24 months, in most of the age-matched males the SV was evidently deteriorated. The results demonstrate more pronounced age-related changes in the cochlear morphology, hearing thresholds, ABR amplitudes and DPOAE amplitudes in F344 males compared with females.

• Publikační typ
• časopisecké články MeSH

OBJECTIVE: Huntington's disease (HD) is an autosomal, dominantly inherited, neurodegenerative disease. The main clinical features are motor impairment, progressive cognitive deterioration and behavioral changes. The aim of our study was to find out whether patients with HD suffer from disorders of the auditory system. METHODS: A group of 17 genetically verified patients (11 males, 6 females) with various stages of HD (examined by UHDRS - motor part and total functional capacity, MMSE for cognitive functions) underwent an audiological examination (high frequency pure tone audiometry, otoacoustic emissions, speech audiometry, speech audiometry in babble noise, auditory brainstem responses). Additionally, 5 patients underwent a more extensive audiological examination, focused on central auditory processing. The results were compared with a group of age-matched healthy volunteers. RESULTS: Our results show that HD patients have physiologic hearing thresholds, otoacoustic emissions and auditory brainstem responses; however, they display a significant decrease in speech understanding, especially under demanding conditions (speech in noise) compared to age-matched controls. Additional auditory tests also show deficits in sound source localization, based on temporal and intensity cues. We also observed a statistically significant correlation between the perception of speech in noise, and motoric and cognitive functions. However, a correlation between genetic predisposition (number of triplets) and function of inner ear was not found. CONCLUSIONS: We conclude that HD negatively influences the function of the central part of the auditory system at cortical and subcortical levels, altering predominantly speech processing and sound source lateralization. SIGNIFICANCE: We have thoroughly characterized auditory pathology in patients with HD that suggests involvement of central auditory and cognitive areas.

• MeSH
• audiometrie slovní metody   MeSH
• centrální nedoslýchavost diagnóza   etiologie   patofyziologie   MeSH
• dospělí MeSH
• Huntingtonova nemoc komplikace   diagnóza   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• percepce řeči fyziologie   MeSH
• senioři MeSH
• sluchové kmenové evokované potenciály fyziologie   MeSH
• sluchový práh fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• bolest ucha diagnóza   MeSH
• diferenciální diagnóza MeSH
• horečka diagnóza   MeSH
• lymfatické nemoci diagnóza   MeSH
• poruchy sluchu diagnóza   MeSH
• tonzilitida diagnóza   MeSH
• vertigo diagnóza   MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• otorinolaryngologie
• infekční lékařství
• diagnostika
• NLK Publikační typ
• kolektivní monografie

In previous studies (Grécová et al., Eur J Neurosci 29:1921-1930, 2009; Bures et al., Eur J Neurosci 32:155-164, 2010), we demonstrated that after an early postnatal short noise exposure (8 min 125 dB, day 14) changes in the frequency tuning curves as well as changes in the coding of sound intensity are present in the inferior colliculus (IC) of adult rats. In this study, we analyze on the basis of the Golgi-Cox method the morphology of neurons in the IC, the medial geniculate body (MGB) and the auditory cortex (AC) of 3-month-old Long-Evans rats exposed to identical noise at postnatal day 14 and compare the results to littermate controls. In rats exposed to noise as pups, the mean total length of the neuronal tree was found to be larger in the external cortex and the central nucleus of the IC and in the ventral division of the MGB. In addition, the numerical density of dendritic spines was decreased on the branches of neurons in the ventral division of the MGB in noise-exposed animals. In the AC, the mean total length of the apical dendritic segments of pyramidal neurons was significantly shorter in noise-exposed rats, however, only slight differences with respect to controls were observed in the length of basal dendrites of pyramidal cells as well as in the neuronal trees of AC non-pyramidal neurons. The numerical density of dendritic spines on the branches of pyramidal AC neurons was lower in exposed rats than in controls. These findings demonstrate that early postnatal short noise exposure can induce permanent changes in the development of neurons in the central auditory system, which apparently represent morphological correlates of functional plasticity.

• MeSH
• akustická stimulace MeSH
• colliculus inferior růst a vývoj   patologie   MeSH
• dendritické trny patologie   MeSH
• hluk škodlivé účinky   MeSH
• metathalamus růst a vývoj   patologie   MeSH
• nervová síť patologie   MeSH
• neurony patologie   MeSH
• neuroplasticita MeSH
• novorozená zvířata MeSH
• potkani Long-Evans MeSH
• pyramidové buňky patologie   MeSH
• sluchová dráha patologie   MeSH
• sluchové korové centrum růst a vývoj   patologie   MeSH
• věkové faktory MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• bolest ucha * diagnóza   etiologie   klasifikace   MeSH
• diferenciální diagnóza MeSH
• lidé MeSH
• nádory ucha diagnóza   MeSH
• otitida diagnóza   etiologie   MeSH
• syndrom temporomandibulárního kloubu diagnóza   MeSH
• Check Tag
• lidé MeSH

Cíl: Cílem práce bylo provést komplexní zhodnocení faktorů ovlivňujících úspěšnost zachování sluchu při mikrochirurgické léčbě vestibulárního schwannomu (VS). Soubor a metodika: Prospektivně jsme hodnotili soubor 81 pacientů, kteří v období 2008–2010 podstoupili radikální exstirpaci VS retrosigmoidním‑transmeatálním přístupem a v době zákroku měli zachovaný sluch. Hodnotili jsme faktory stran pa­cienta, nádoru, audiometrické parametry a technické aspekty operace. Parametry byly statisticky vyhodnoceny včetně regresivní analýzy nezávislých proměnných. Výsledky: Sluch se podařilo zachovat u 17 pacientů (tzv. užitečný sluch: devět; tzv. neužitečný sluch: osm). U dvou pacientů jsme zaznamenali zlepšení z neužitečné úrovně na sluch užitečný. Velikost VS byla ve skupině se zachovaným sluchem menší (p < 0,001), převažovaly tak nádory nižších stadií (p = 0,001). Hloubka zasahování do vnitřního zvukovodu nevykazovala vztah k úspěšnosti zachování sluchu. K významným faktorům ovlivňujícím výsledek patřila předoperační úroveň sluchu (p < 0,001) včetně typu odpovědi v BERA (p = 0,03). Užití intraoperační BERA bylo pro výsledek klíčové (p < 0,001). Úspěšnost zachování BERA však s výsledkem nekorelovala. Ke klíčovým faktorům ovlivňujícím uchování sluchu patřila úspěšná identifikace kochleárního nervu (p < 0,001), užití endoskopické techniky (p < 0,001), měkká konzistence tumoru (p = 0,05) a absence adhezí k neurovaskulárním strukturám (p < 0,001). Krvácivost ani přítomnost cystické komponenty úspěšnost uchování sluchu neovlivnily. Závěry: Mimo zkušenost chirurgického týmu patří k hlavním faktorům ovlivňujícím uchování sluchu velikost nádoru, úroveň sluchu před operací a možnost užití intraoperačního monitoringu sluchu. Klíčová je identifikace kochleární porce n. VIII. Z tohoto hlediska se jeví přínosné užití endoskopické techniky. K významným intraoperačním faktorům pak náleží měkká konzistence tumoru a absence adhezí k neurovaskulárním strukturám.

Aim: The aim of the study was to conduct a comprehensive analysis of the factors influencing the success rate of hearing preservation in patients undergoing microsurgical removal of vestibular schwannoma (VS). Materials and methods: A total of 81 consecutive patients with serviceable hearing underwent surgical removal of unilateral vestibular schwannoma via retrosigmoid-transmeatal approach between 2008 and 2010. Patient, tumor and audiometric parameters together with intraoperative findings were prospectively analyzed. Data were statistically processed including a regression analysis of independent variables. Results: Serviceable hearing was preserved in 17 patients (useful hearing in nine and non-useful in eight cases). We observed improvement of hearing from non-useful to useful level in two patients. Average size of VS was smaller in the preserved hearing group (p < 0.001) where lower stage tumors prevailed (p = 0.001). Extent of internal auditory canal filling did not correlate with the result. Preoperative hearing level (p < 0.001) and the type of brainstem auditory evoked response (p = 0.03) arose as significant prognostic factors. Employment of intraoperative BERA was crucial for the outcome (p < 0.001) but success rate of its preservation was not correlated with the result. Identification of the cochlear nerve (p < 0.001), employment of endoscopic technique (p < 0.001), soft consistency of the tumor (p = 0.05) and the lack of adhesions to the neurovascular structures (p < 0.001) proved to be crucial factors affecting the preservation of hearing. Neither hypervascularity nor the presence of cystic component affected outcome. Conclusions: Apart from the experience of the surgical team, size of the tumor, preoperative hearing level and possibility of intraoperative hearing monitoring represented the main factors for hearing preservation. Early identification of the cochlear portion of the CN VIII is key. For this, the use of endoscopic technique seems to be beneficial. Soft consistency of tumor and lack of adhesions to the neurovascular structures represent crucial intraoperative factors. Key words: vestibular schwannoma – acoustic neuroma – hearing preservation – microsurgery – retrosigmoid approach – intraoperative neuromonitoring The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

• Klíčová slova
• uchování sluchu, intraoperační neuromonitoring, retrosigmoidní přístup,
• MeSH
• audiometrie MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrochirurgie * MeSH
• mladý dospělý MeSH
• nedoslýchavost * diagnóza   prevence a kontrola   MeSH
• neurochirurgické výkony MeSH
• neurofyziologický monitoring MeSH
• otorinolaryngologické chirurgické výkony MeSH
• peroperační monitorování MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• regresní analýza MeSH
• senioři MeSH
• sluchové evokované potenciály MeSH
• vestibulární schwannom * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

Hearing loss, presbycusis, is one of the most common sensory declines in the ageing population. Presbycusis is characterised by a deterioration in the processing of temporal sound features as well as a decline in speech perception, thus indicating a possible central component. With the aim to explore the central component of presbycusis, we studied the function of the auditory cortex by functional MRI in two groups of elderly subjects (>65 years) and compared the results with young subjects (

• MeSH
• akustické impedanční testy MeSH
• audiometrie čistými tóny MeSH
• audiometrie slovní MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mapování mozku MeSH
• presbyakuze patofyziologie   radiografie   MeSH
• senioři MeSH
• sluchové korové centrum patofyziologie   radiografie   MeSH
• sluchový práh MeSH
• stárnutí * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: The aim of this study was to analyze the effect of vestibular schwannoma microsurgery via the retrosigmoid-transmeatal approach with special reference to the postoperative tinnitus outcome. MATERIAL AND METHODS: A prospective study was performed in 89 consecutive patients with unilateral vestibular schwannoma indicated for microsurgery. Patient and tumor related parameters, pre- and postoperative hearing level, intraoperative findings, and hearing and tinnitus handicap inventory scores were analyzed. RESULTS: Cochlear nerve integrity was achieved in 44% corresponding to preservation of preoperatively serviceable hearing in 47% and useful hearing in 21%. Main prognostic factors of hearing preservation were grade/size of tumor, preoperative hearing level, intraoperative neuromonitoring, tumor consistency, and adhesion to neurovascular structures. Microsurgery led to elimination of tinnitus in 66% but also new-onset of the symptom in 14% of cases. Preservation of useful hearing and neurectomy of the eighth cranial nerve were main prognostic factors of tinnitus elimination. Preservation of cochlear nerve but loss of preoperative hearing emerged as the main factor for tinnitus persistence and new onset tinnitus. Decrease of THI scores was observed postoperatively. CONCLUSIONS: Our results underscore the importance of proper pre- and intraoperative decision making about attempt at hearing preservation versus potential for tinnitus elimination/risk of new onset of tinnitus.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrochirurgie škodlivé účinky   MeSH
• nervus cochlearis chirurgie   MeSH
• neurochirurgické výkony škodlivé účinky   MeSH
• pooperační komplikace etiologie   MeSH
• prospektivní studie MeSH
• sluch fyziologie   MeSH
• tinnitus etiologie   MeSH
• vestibulární schwannom chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Age-related hearing loss (presbycusis) is caused mainly by the hypofunction of the inner ear, but recent findings point also toward a central component of presbycusis. We used MR morphometry and diffusion tensor imaging (DTI) with a 3T MR system with the aim to study the state of the central auditory system in a group of elderly subjects (>65years) with mild presbycusis, in a group of elderly subjects with expressed presbycusis and in young controls. Cortical reconstruction, volumetric segmentation and auditory pathway tractography were performed. Three parameters were evaluated by morphometry: the volume of the gray matter, the surface area of the gyrus and the thickness of the cortex. In all experimental groups the surface area and gray matter volume were larger on the left side in Heschl's gyrus and planum temporale and slightly larger in the gyrus frontalis superior, whereas they were larger on the right side in the primary visual cortex. Almost all of the measured parameters were significantly smaller in the elderly subjects in Heschl's gyrus, planum temporale and gyrus frontalis superior. Aging did not change the side asymmetry (laterality) of the gyri. In the central part of the auditory pathway above the inferior colliculus, a trend toward an effect of aging was present in the axial vector of the diffusion (L1) variable of DTI, with increased values observed in elderly subjects. A trend toward a decrease of L1 on the left side, which was more pronounced in the elderly groups, was observed. The effect of hearing loss was present in subjects with expressed presbycusis as a trend toward an increase of the radial vectors (L2L3) in the white matter under Heschl's gyrus. These results suggest that in addition to peripheral changes, changes in the central part of the auditory system in elderly subjects are also present; however, the extent of hearing loss does not play a significant role in the central changes.

• MeSH
• centrální poruchy sluchu patologie   MeSH
• dospělí MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mladý dospělý MeSH
• nervová vlákna myelinizovaná patologie   MeSH
• presbyakuze patologie   patofyziologie   MeSH
• senioři MeSH
• sluchová dráha patologie   MeSH
• sluchové korové centrum patologie   MeSH
• stárnutí patologie   fyziologie   MeSH
• zobrazování difuzních tenzorů MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH