Post-Surgery Check Prevents Complications

Swallowing and voice troubles may signal complications after removing benign nerve tumors

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Surgically removing benign tumors at the base of the brain can lead to complications. A quick post-surgery evaluation of voice and swallowing may identify problems.

Doctors may head off possible complications for patients following surgery by assessing their ability to speak, chew and swallow within 24 hours of removing benign brain tumors. These tumors can be safely removed and relieve dizziness, hearing loss and other symptoms.

Catching problems early has the potential to reduce hospital stays and lower costs.

"Know post-surgery symptoms that may signal health complications."

Lee Akst, MD, laryngologist and senior co-investigator for this study from the Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, investigated if lower cranial nerve injury was a risk for patients undergoing vestibular schwannoma surgery.

Vestibular schwannomas (also known as acoustic neuromas) are benign, usually slow-growing, tumors that develop at the base of the brain. The tumors result from an overproduction of cells that help protect and insulate nerves connected to the inner ear.

From hospital records of 17,261 men and women who participated in the National Inpatient Survey (NIS), investigators discovered that 443 patients who had these tumors removed reported swallowing problems, or dysphagia. Also, 117 patients experienced some form of vocal paralysis.

Scientists noted that the treatment of dysphagia and vocal cord paralysis could lead to other illnesses, including pneumonia, especially if patients needed feeding or breathing tubes implanted.

The complications often led to longer, costlier hospital stays, or additional care at rehabilitation facilities. When there were no complications, the average hospital stay was 5.3 days; when dysphagia occurred, the average stay was 11.7 days, and when there was vocal cord paralysis, the average stay was 12.1 days.

Patients who developed swallowing problems were almost twice as likely to be sicker than patients whose swallowing remained normal. Dysphagic patients were nearly 18 times more likely to aspirate food into their lungs than non-dysphagic patients. One in five needed a feeding or gastrostomy tube installed. For patients with vocal chord paralysis, one in eight needed a breathing or tracheostomy tube placed in their throat to enable speech.

Scientists estimated that the increased cost of care for such post-surgical problems ranged between $35,000 and $50,000 per patient.

Christine Gourin, MD, senior co-investigator and director of the Clinical Research Program in Head and Neck Cancer at Johns Hopkins’ Kimmel Cancer Center, said that patients who develop complications can turn to rehabilitative therapies, including drug therapies and other surgery, but these remedies produce their best results when administered early.

In order to take action early, Dr. Akst says, "Physicians and speech therapists really need to closely monitor their patients for early signs and symptoms, such as breathy, whispery voices and trouble keeping food in their mouth while chewing, so that aggressive therapy with exercise, medications or further surgery can be quickly considered.”

Researchers say the team next plans to study what social and pre-existing medical conditions might put patients at greater risk of post-surgical complications. Scientists hope that by monitoring patients before they have surgery, they can gain a better understanding of who does and does not develop dysphagia and vocal cord paralysis. The team also has plans to evaluate which medical and rehabilitative therapies work best at resolving the problems.

This study was published in the December issue of the journal The Laryngoscope. Funding support for this study was provided by The Johns Hopkins Hospital.

Reviewed by: 
Review Date: 
December 13, 2012
Last Updated:
December 18, 2012