Ann Otolaryngol Chir Cervicofac 1999 Oct;116(5):285-90
Minor functional disorders after surgery of acoustic nerve neuroma
Pialoux R, Coffinet L, Simon C, Beurton R

Acoustic neuromas must be removed surgically, otherwise serious complications may occur. Removal of an acoustic neuroma most often leads to disorders of balance, hearing, and sometimes facial motor function. Many earlier studies have approached the hearing and facial motor function. However, the facial nerve also comprises sensory and secretory fibers which, when injured, may produce minor disorders affecting patient's quality of life. The purpose of this work was to evaluate the quality of life, secretory and taste disorders after acoustic neuroma surgery.

PATIENTS AND METHOD: Among patients operated on between May 1985 and May 1996, we selected only those who presented a normal facial function 3 months after surgery. We thus selected 93 patients and sent them a questionnaire in December 1997. We received 74 answers.

RESULTS: The period between the operation and the dispatch of the questionnaire was on an average 5.5 years (range 19 months-12 years 9 months). Impairment of quality of life was frequent (59% of cases), and changing way of life less so (30%). 74% of the patients described balance disorders. One-quarter of the patients indicated they experienced disorders of facial mobility. Only 3 patients had no disorder.

CONCLUSION: Secretory and taste disorders are frequent after neuroma surgery. Despite their mildness, patients should be advised accordingly because of possible impact on quality of life. This study also points out the lack of precision in the estimation of facial mobility. A better evaluation of patient complaints would be useful.

Ann Otolaryngol Chir Cervicofac 1999 Oct;116(5):285-90
Minor functional disorders after surgery of acoustic nerve neuroma
Pialoux R, Coffinet L, Simon C, Beurton R

Acoustic neuromas must be removed surgically, otherwise serious complications may occur. [Must be removed surgically? Actually the reverse is true. Serious complications may occur if acoustic neuromas are removed surgically.] Removal of an acoustic neuroma most often leads to disorders of balance, hearing, and sometimes facial motor function.[A true statement!] Many earlier studies have approached the hearing and facial motor function. However, the facial nerve also comprises sensory and secretory fibers which, when injured, may produce minor disorders affecting patient's quality of life.[The term "minor disorders" is a real problem for me; because, as some of you know by experience, facial nerve damage can be very serious.] The purpose of this work was to evaluate the quality of life, secretory and taste disorders after acoustic neuroma surgery.[This is a worthy purpose; but let's examine the methods and results to see if the conclusion is really valid or just a bunch of neurosurgeon bull.]

PATIENTS AND METHOD: Among patients operated on between May 1985 and May 1996, we selected only those who presented a normal facial function 3 months after surgery. [Talk about front loading a survey . . . they selected patients who had normal facial function 3 months after surgery; I guess they didn't want to hear from patients who had facial neuropathy immediately following surgery and who still had facial neuropathy 3 months post-op.] We thus selected 93 patients and sent them a questionnaire in December 1997. We received 74 answers. [Not a bad return rate as surveys go, but the 1999 ANA patient survey had 1550 responders.]

RESULTS: The period between the operation and the dispatch of the questionnaire was on an average 5.5 years (range 19 months-12 years 9 months). [Big deal, the time period that matters is the "3 months after surgery."] Impairment of quality of life was frequent (59% of cases), and changing way of life less so (30%). 74% of the patients described balance disorders. One-quarter of the patients indicated they experienced disorders of facial mobility. Only 3 patients had no disorder.[These are significant statistics, and they do not paint a pretty picture when you consider that only the "cream of the crop" participated in the study (persons with normal facial function 3 months post-op).]

CONCLUSION: Secretory and taste disorders are frequent after neuroma surgery.[A true statement!] Despite their mildness, patients should be advised accordingly because of possible impact on quality of life. [Again, the use of the term "mildness" bothers me, just like the term "minor disorders" did above.] This study also points out the lack of precision in the estimation of facial mobility.[This study does a better job at showing how selection of study participants can drive study results; and it is also a great example of sugar-coating statistics--judging them to be mild or minor when they clearly are not. Surgeons can become calloused in looking at numbers, forgetting that there is a person attached to that brain who has the rest of his/her life to live with whatever deficit surgery leaves.] A better evaluation of patient complaints would be useful. [Many studies have a caveat like this at the end. Why? To give them an out if their findings are way off base. One I saw just the other day that said, "Longer follow-up will be required . . . " Same diff! ]

So now the big question:
Do you think the title of the research paper was accurate and that it proved that only minor functional disorders result from acoustic nerve neuroma surgery?

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