- Design
- Systematic review and meta-analysis of 11 studies
- Population
- 4,014 adults having microvascular decompression for hemifacial spasm
- Primary outcome
- Permanent postoperative hearing loss
- Effect
- 2.6% (95% CI 1.1–5.9%); I² 87.4%
This systematic review pooled 11 studies with 4,014 adults who had microvascular decompression for hemifacial spasm and objective hearing tests before and after.
Permanent postoperative hearing loss occurred in about 2.6%, with wide variation between studies. Prospective studies, which tend to look harder, reported about 5% against 2% in retrospective studies, though the difference was not significant.
Risk was linked to changes in brainstem auditory evoked responses during surgery, particularly wave V latency and amplitude, and to greater depth, distance and duration of cerebellar retraction.
For ENT surgeons this is mainly a counselling and assessment point: patients considering decompression should have a baseline audiogram and be told that permanent hearing loss is uncommon but real, and the risk may be higher than retrospective series suggest.
- Get a baseline audiogram before microvascular decompression for hemifacial spasm.
- Counsel patients that permanent hearing loss occurs in a few per cent.
- Support intraoperative auditory evoked response monitoring during decompression.
- Repeat audiometry after surgery if hearing changes are reported.
Why it matters
Hearing loss is the complication patients least expect from an operation aimed at the face.
The statistics, in plain English
The 2.6% estimate has an interval from 1.1% to 5.9% and very high heterogeneity, so the true risk in a given centre could be well above or below it.
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