Ipsilateral cochlear implantation in patients with sporadic vestibular schwannoma in the only or best hearing ear and in patients with NF2

Abstract

The aim of this study was to evaluate the cochlear implant (CI) performances in neurofibromatosis type 2 (NF2) patients with bilateral vestibular schwannoma (VS) and in patients with sporadic VS in the only or better hearing ear. All patients with bilateral VS or sporadic VS in the only or better hearing ear who underwent cochlear implantation, either simultaneous to VS surgery or staged after treatment for VS, in the tumor side were chosen for the study. Postimplantation audiometric scores (sound detection, closed-set and open-set discrimination scores) and device use patterns were the main outcome measures. 15 patients were implanted. Eight patients (53 %) were NF2 and seven patients had VS in the only or better hearing ear. One patient was explanted for cerebrospinal fluid leak. In the CI-only condition, the other 14 patients obtained sound detection, 64 % of them achieving open-set discrimination (mean 70 ± 38 %) and 85 % achieving closed-set discrimination (mean 41 ± 33 %). At the last follow-up 10 patients (67 %) were using the CI. Cochlear implantation provides hearing in particular cases of patients with bilateral VS or VS in the only or better hearing ear. As long as anatomic preservation of the cochlear nerve is achieved, cochlear implantation may offer improvement in communication skills for most patients.

Vestibular Schwannoma Resection with Ipsilateral Simultaneous Cochlear Implantation in Patients with Normal Contralateral Hearing

“…However, their results do not reach those of standard postlingually deaf patients in the majority of cases [Arriaga and Marks, 1995;Aristegui and Denia, 2005;Zannetti et al, 2008;Di Lella et al, 2013;Lassaletta et al, 2016]. In addition, little is known about their benefits in the presence of normal contralateral hearing.…”

“…Cochlear implantation has been previously described for the hearing rehabilitation of patients with NF-2 and sporadic VS in the only or better hearing ear [Lustig et al, 2006;Odat et al, 2011;Carlson et al, 2012;Di Lella et al, 2013;Lloyd et al, 2014;Aristegui and Denia, 2015;Lassaletta et al, 2016]. However, little is known about their benefits in the presence of normal contralateral hearing after VS resection.…”

“…Nevertheless, in cases of sporadic VS with normal contralateral hearing, if residual tumor is left intentionally or unintentionally, it is the recommendation of the author to abort CI placement, as oncological surveillance is prioritized. Patients with impaired contralateral hearing or NF-2 deserve separate consideration and can benefit from other strategies of management such as contralateral CI or CI without tumoral resection [Di Lella et al, 2013;Lassaletta et al, 2016].…”

“…Even with hearing preservation surgery, the chances of maintaining social serviceable hearing in the short term range from 0 to 37% in the most experienced hands [Rabelo de Freitas et al, 2012]. Patients with neurofibromatosis type 2 (NF-2) or VS in the only or better hearing ear deserve separate consideration, as they are at special risk of developing bilateral anacusia, either as a consequence of treatment or from the natural course of the disease [Vincenti et al, 2008;Celis-Aguilar et al, 2012;Lassaletta et al, 2016].…”

Management of sporadic vestibular schwannoma with contralateral nonserviceable hearing

“…Management of sporadic vestibular schwannoma (VS) in the only hearing ear represents a difficult challenge in neuro‐otology . During the last two decades, the number of VS diagnosed has increased dramatically, mainly due to the wide diffusion and easy access to magnetic resonance imaging (MRI).…”