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J Neurol Surg Rep 2016; 77(01): e56-e61
DOI: 10.1055/s-0035-1570389
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Denervation of the Eustachian Tube and Hearing Loss Following Trigeminal Schwannoma Resection

Christopher J. Ito
1   Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, United States
,
Alexander K. Malone
1   Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, United States
,
Ricky H. Wong
2   Skull Base and Pituitary Surgery, NorthShore University Health System, Evanston, Illinois, United States
,
Harry R. van Loveren
3   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
,
K. Paul Boyev
1   Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, United States
› Author Affiliations
Further Information

Publication History

18 October 2015

17 November 2015

Publication Date:
01 March 2016 (online)

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Abstract

Objectives To discuss eustachian tube dysfunction (ETD) as a cause of hearing loss and to discuss its pathogenesis following resection of trigeminal schwannomas.

Methods Presented herein are two cases of trigeminal schwannoma that were resected surgically with sacrifice of the motor branch of the trigeminal nerve. Neither of the cases had evidence of extracranial extension nor preoperative ETD. Both patients developed ETD and have been followed without evidence of schwannoma recurrence.

Conclusions Trigeminal schwannomas are rare tumors that typically require surgical resection. Hearing loss is a potential postsurgical deficit and warrants evaluation by an otolaryngologist with consideration given to a preoperative audiogram. ETD as a result of trigeminal motor branch sacrifice should be included in the differential diagnosis of postoperative hearing loss in this patient subset as it may be reversed with placement of a tympanostomy tube.

Keywords

eustachian tube dysfunction - trigeminal schwannoma - hearing loss - trigeminal nerve - patulous ET

Presented at North American Skull Base Society Meeting in Tampa, FL February 20-22, 2015.


 

  • References

  • 1 Schmidt RF, Yick F, Boghani Z, Eloy JA, Liu JK. Malignant peripheral nerve sheath tumors of the trigeminal nerve: a systematic review of 36 cases. Neurosurg Focus 2013; 34 (3) E5
    PubMedGoogle Scholar
  • 2 Levy WJ, Ansbacher L, Byer J, Nutkiewicz A, Fratkin J. Primary malignant nerve sheath tumor of the gasserian ganglion: a report of two cases. Neurosurgery 1983; 13 (5) 572-576
    CrossrefPubMedGoogle Scholar
  • 3 Al-Mefty O, Ayoubi S, Gaber E. Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. J Neurosurg 2002; 96 (3) 453-463
    CrossrefPubMedGoogle Scholar
  • 4 Taha JM, Tew Jr JM, van Loveren HR, Keller JT, el-Kalliny M. Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. J Neurosurg 1995; 82 (5) 719-725
    CrossrefPubMedGoogle Scholar
  • 5 Day JD, Fukushima T. The surgical management of trigeminal neuromas. Neurosurgery 1998; 42 (2) 233-240 , discussion 240–241
    CrossrefPubMedGoogle Scholar
  • 6 Guthikonda B, Theodosopoulos PV, van Loveren H, Tew Jr JM, Pensak ML. Evolution in the assessment and management of trigeminal schwannoma. Laryngoscope 2008; 118 (2) 195-203
    CrossrefPubMedGoogle Scholar
  • 7 McCormick PC, Bello JA, Post KD. Trigeminal schwannoma. Surgical series of 14 cases with review of the literature. J Neurosurg 1988; 69 (6) 850-860
    CrossrefPubMedGoogle Scholar
  • 8 Pollack IF, Sekhar LN, Jannetta PJ, Janecka IP. Neurilemomas of the trigeminal nerve. J Neurosurg 1989; 70 (5) 737-745
    CrossrefPubMedGoogle Scholar
  • 9 Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg 1999; 91 (2) 202-211
    CrossrefPubMedGoogle Scholar
  • 10 Yasui T, Hakuba A, Kim SH, Nishimura S. Trigeminal neurinomas: operative approach in eight cases. J Neurosurg 1989; 71 (4) 506-511
    CrossrefPubMedGoogle Scholar
  • 11 Seibert JW, Danner CJ. Eustachian tube function and the middle ear. Otolaryngol Clin North Am 2006; 39 (6) 1221-1235
    CrossrefPubMedGoogle Scholar
  • 12 Graves GO, Edwards LF. The eustachian tube: a review of its descriptive, microscopic, topographic and clinical anatomy. Arch Otolaryngol 1944; 39 (5) 359-379
    CrossrefPubMedGoogle Scholar
  • 13 Prades JM, Dumollard JM, Calloc'h F, Merzougui N, Veyret C, Martin C. Descriptive anatomy of the human auditory tube. Surg Radiol Anat 1998; 20 (5) 335-340
    CrossrefPubMedGoogle Scholar
  • 14 Cantekin EI, Doyle WJ, Bluestone CD. Effect of levator veli palatini muscle excision on eustachian tube function. Arch Otolaryngol 1983; 109 (5) 281-284
    CrossrefPubMedGoogle Scholar
  • 15 Honjo I, Okazaki N, Kumazawa T. Experimental study of the Eustachian tube function with regard to its related muscles. Acta Otolaryngol 1979; 87 (1–2) 84-89
    CrossrefPubMedGoogle Scholar
  • 16 Swarts JD, Rood SR. The morphometry and three-dimensional structure of the adult eustachian tube: implications for function. Cleft Palate J 1990; 27 (4) 374-381
    CrossrefPubMedGoogle Scholar
  • 17 Proctor B. Anatomy of the eustachian tube. Arch Otolaryngol 1973; 97 (1) 2-8
    CrossrefPubMedGoogle Scholar
  • 18 Kumazawa T. Objective tubal function test. In: Kumazawa T, , ed. A basic and clinical study on the Eustachian tube. Osaka (Japan): Kansai Medical University; 1980: 4-29
    Google Scholar
  • 19 Cantekin EI, Doyle WJ, Reichert TJ, Phillips DC, Bluestone CD. Dilation of the eustachian tube by electrical stimulation of the mandibular nerve. Ann Otol Rhinol Laryngol 1979; 88 (1 Pt 1) 40-51
    CrossrefPubMedGoogle Scholar
  • 20 Doyle WJ, Cantekin EI, Bluestone CD, Phillips DC, Kimes KK, Siegel MI. Nonhuman primate model of cleft palate and its implications for middle ear pathology. Ann Otol Rhinol Laryngol Suppl 1980; 89 (3 Pt 2) 41-46
    PubMedGoogle Scholar
  • 21 Ross MA. Functional anatomy of the tensor palati. Its relevance in cleft palate surgery. Arch Otolaryngol 1971; 93 (1) 1-3 , passim
    CrossrefPubMedGoogle Scholar
  • 22 O'Reilly RC, Sando I. Anatomy and Physiology of the Eustachian Tube. In: Flint PW, Cummings CW, , eds. Cummings Otolaryngology head & neck surgery. Philadelphia: Mosby/Elsevier; 2010: 1866-75
    CrossrefGoogle Scholar
  • 23 Franz B, Anderson CR. The effect of the sympathetic and sensory nervous system on active eustachian tube function in the rat. Acta Otolaryngol 2007; 127 (3) 265-272
    CrossrefPubMedGoogle Scholar
  • 24 Proctor B. Embryology and anatomy of the eustachian tube. Arch Otolaryngol 1967; 86 (5) 503-514
    CrossrefPubMedGoogle Scholar
  • 25 Mitchell GAC. The autonomic nerve supply of the throat, nose and ear. J Laryngol Otol 1954; 68 (8) 495-516
    CrossrefPubMedGoogle Scholar
  • 26 Nathanson SE, Jackson RT. Vidian nerve and the eustachian tube. Ann Otol Rhinol Laryngol 1976; 85 (1 Pt 1) 83-85
    CrossrefPubMedGoogle Scholar
  • 27 Ishijima K, Sando I, Miura M, Balaban CD, Takasaki K, Sudo M. Postnatal development of static volume of the eustachian tube lumen. A computer-aided three-dimensional reconstruction and measurement study. Ann Otol Rhinol Laryngol 2002; 111 (9) 832-835
    CrossrefPubMedGoogle Scholar
  • 28 Hsu MM, Young YH, Lin KL. Eustachian tube function of patients with nasopharyngeal carcinoma. Ann Otol Rhinol Laryngol 1995; 104 (6) 453-455
    CrossrefPubMedGoogle Scholar
  • 29 Young YH, Sheen TS. Preservation of tubal function in patients with nasopharyngeal carcinoma, post-irradiation. Acta Otolaryngol 1998; 118 (2) 280-283
    CrossrefPubMedGoogle Scholar
  • 30 Myers EN, Beery QC, Bluestone CD, Rood SR, Sigler BA. Effect of certain head and neck tumors and their management on the ventilatory function of the eustachian tube. Ann Otol Rhinol Laryngol Suppl 1984; 114: 3-16
    PubMedGoogle Scholar
  • 31 Gopen Q. Pathology and Clinical Course of the Inflammatory Diseases of the Middle Ear. In: Gulya A, Minor L, Poe D, , eds. Surgery of the Ear 6th ed. Shelton, CT: People's Medical Publishing House-USA; 2010: 425-436
    Google Scholar
  • 32 O'Connor AF, Shea JJ. Autophony and the patulous eustachian tube. Laryngoscope 1981; 91 (9 Pt 1) 1427-1435
    CrossrefPubMedGoogle Scholar
  • 33 Nager GT. Neurinomas of the trigeminal nerve. Am J Otolaryngol 1984; 5 (5) 301-333
    CrossrefPubMedGoogle Scholar
  • 34 Wanibuchi M, Fukushima T, Zomordi AR, Nonaka Y, Friedman AH. Trigeminal schwannomas: skull base approaches and operative results in 105 patients. Neurosurgery 2012; 70 (1, Suppl Operative) 132-143 , discussion 143–144
    PubMedGoogle Scholar
  • 35 Jefferson G. The trigeminal neurinomas with some remarks on malignant invasion of the gasserian ganglion. Clin Neurosurg 1953; 1: 11-54
    PubMedGoogle Scholar
  • 36 Samii M, Migliori MM, Tatagiba M, Babu R. Surgical treatment of trigeminal schwannomas. J Neurosurg 1995; 82 (5) 711-718
    CrossrefPubMedGoogle Scholar
  • 37 Dolenc VV. Frontotemporal epidural approach to trigeminal neurinomas. Acta Neurochir (Wien) 1994; 130 (1–4) 55-65
    CrossrefPubMedGoogle Scholar
  • 38 Silvola J, Kivekäs I, Poe DS. Balloon Dilation of the Cartilaginous Portion of the Eustachian Tube. Otolaryngol Head Neck Surg 2014; 151 (1) 125-130
    CrossrefPubMedGoogle Scholar