Cochlear Implantation in Sporadic Vestibular Schwannoma: A Systematic Literature Review

Abstract

Objective This study was aimed to perform a systematic literature review by examining outcomes in patients with sporadic vestibular schwannoma (VS) undergoing ipsilateral cochlear implant (CI). Data Sources PubMed-NCBI (National Center for Biotechnology Information) and Scopus databases were searched through October 2017. Study Selection Studies reporting auditory outcomes for each patient when a CI was placed with an ipsilateral sporadic VS were included. Main Outcome Measures Demographic variables, VS characteristics, preoperative hearing metrics, duration of deafness, CI type, approach to tumor resection, postoperative auditory outcomes, and postoperative tinnitus outcomes were reported for each eligible patient within studies. Each study was evaluated for quality and bias. Results Fifteen studies and 45 patients met inclusion criteria. Mean speech discrimination score (SDS) improved from 30.0 to 56.4% after CI placement. The majority when reported had an improvement in tinnitus. Preoperative ipsilateral SDS was a negative predictor of postoperative SDS, while neither tumor resection status, tumor location, duration of deafness, ipsilateral pure tone average, nor timing of CI placement had a significant effect on patient outcome. Conclusions Notwithstanding the challenges inherent with surveillance magnetic resonance imaging (MRI) in the setting of a cochlear implant magnet, select sporadic vestibular schwannoma patients can be considered for cochlear implantation.

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

“…Through transcranial direct bone conduction to the contralateral cochlea, BAHAs eliminate the head shadow and enable patients to hear and communicate on the deaf side. These devices have been proven to restore some binaural hearing, thus improving the patients' QoL [9]. While providing no benefit for sound localization, BAHAs improve speech discrimination in noisy surroundings, thereby diminishing the social, physical, and psychological stress.…”

“…While providing no benefit for sound localization, BAHAs improve speech discrimination in noisy surroundings, thereby diminishing the social, physical, and psychological stress. A systematic review on functional outcomes after cochlear implant (CIs) in patients with sporadic VSs reported a 30 to 56.4% improvement in mean speech discrimination score and an improvement in tinnitus [9]. Although the use of follow-up MRIs in patients with CIs is considered to be limited due to imaging artifacts [9], Carlson et al [22] showed that under controlled conditions, 1.5-T MRI can successfully evaluate the ipsilateral skull base.…”

“…A systematic review on functional outcomes after cochlear implant (CIs) in patients with sporadic VSs reported a 30 to 56.4% improvement in mean speech discrimination score and an improvement in tinnitus [9]. Although the use of follow-up MRIs in patients with CIs is considered to be limited due to imaging artifacts [9], Carlson et al [22] showed that under controlled conditions, 1.5-T MRI can successfully evaluate the ipsilateral skull base. Notwithstanding this limitation, select sporadic VS patients can be considered for CIs [9].…”

“…Although the use of follow-up MRIs in patients with CIs is considered to be limited due to imaging artifacts [9], Carlson et al [22] showed that under controlled conditions, 1.5-T MRI can successfully evaluate the ipsilateral skull base. Notwithstanding this limitation, select sporadic VS patients can be considered for CIs [9]. Proper counseling is required to ensure that patients are informed about long-term hearing prognosis at the time of diagnosis.…”

Hörklassen bei Patienten mit Vestibularisschwannom bei Verwendung deutschsprachiger Testverfahren

“…Die American Academy of Otolaryngology -Head and Neck Surgery (AAO-HNO) schlägt 4 Klassen (A-D) vor [1], wohingegen die Klassifikation nach Gardner und Robertson [10] 5 Klassen [1][2][3][4][5] unterscheidet und auf die Silverstein-Klassifikation (Klassen I-V) zurückgeht [35]. Im deutschsprachigen Raum wurde die "New-Hannover-Klassifikation" mit 5 Stufen (H1-H5) entwickelt [29].…”