Objective: To assess the efficacy of cochlear implantation (CI) after surgical removal of sporadic intracochlear or intravestibulocochlear schwannomas. Study Design: Nonconcurrent cohort study. Setting: Monocentric study at a tertiary referral center. Patients: Patients with tumor resection and CI between 2011 and 2018 and a historic control group of CI patients matched by age, CI electrode type, and follow-up. Interventions: Partial or subtotal cochleoectomy for tumor removal and single-stage CI. Outcome Measures: Main outcome measure: word recognition score for monosyllables in quiet at 65 dB SPL. Results: Sixteen patients with tumor removal and CI (6 female, 10 male; mean age 55 ± 14 years) and 16 control patients (6 female, 10 male; mean age 55 ± 15 years) were identified. In the tumor group, surprisingly good word recognition scores were reached even after substantial structural defects in the cochlear capsule. While 12 months after cochlear implantation mean word recognition score for monosyllables in quiet was 58% (SD: 26) and 41% (SD: 26) in the control groups, it was 75% (SD: 19%) in the tumor group. Conclusions: In patients with intracochlear schwannomas, despite substantial structural damage to the cochlear capsule by partial or subtotal cochleoectomy, a tendency toward better performance with respect to word recognition with CI was observed as compared with other CI patients. The surprisingly good functional results despite substantial cochlear trauma may change clinical thinking with respect to cochlear implantation also beyond this special indication.

Daily-life conversation relies on speech perception in quiet and noise. Because of the COVID-19 pandemic, face masks have become mandatory in many situations. Acoustic attenuation of sound pressure by the mask tissue reduces speech perception ability, especially in noisy situations. Masks also can impede the process of speech comprehension by concealing the movements of the mouth, interfering with lip reading. In this prospective observational, cross-sectional study including 17 participants with normal hearing, we measured the influence of acoustic attenuation caused by medical face masks (mouth and nose protection) according to EN 14683 and of N95 masks according to EN 1149 (EN 14683) on the speech recognition threshold and listening effort in various types of background noise. Averaged over all noise signals, a surgical mask significantly reduced the speech perception threshold in noise was by 1.6 dB (95% confidence interval [CI], 1.0, 2.1) and an N95 mask reduced it significantly by 2.7 dB (95% CI, 2.2, 3.2). Use of a surgical mask did not significantly increase the 50% listening effort signal-to-noise ratio (increase of 0.58 dB; 95% CI, 0.4, 1.5), but use of an N95 mask did so significantly, by 2.2 dB (95% CI, 1.2, 3.1). In acoustic measures, mask tissue reduced amplitudes by up to 8 dB at frequencies above 1 kHz, whereas no reduction was observed below 1 kHz. We conclude that face masks reduce speech perception and increase listening effort in different noise signals. Together with additional interference because of impeded lip reading, the compound effect of face masks could have a relevant impact on daily life communication even in those with normal hearing.

Purpose Evaluating the effectiveness of intraoperative auditory brainstem responses (ABRs) to stimulation by the Vibrant Soundbridge (VSB) active middle ear implant for quantifying the implant's floating mass transducer (FMT) coupling quality. Methods In a diagnostic multicentric study, patients (> 18 years) who received a VSB with different coupling modalities were included. Pre-and postoperative bone conduction thresholds, intraoperative VSB-evoked ABR thresholds (VSB-ABR) using a modified audio processor programmed to preoperative bone conduction thresholds, postoperative vibrogram thresholds, and postoperative VSB-ABR thresholds were measured. Coupling quality was calculated from the difference between the pure tone average at 1000, 2000, and 4000 Hz (3PTA) vibrogram and postoperative 3PTA bone conduction thresholds. Results Twenty-three patients (13 males, 10 females, mean age 56.6 (± 12.5) years) were included in the study. Intraoperative VSB-ABR response thresholds could be obtained in all except one patient where the threshold was > 30 dB nHL. Postoperatively, an insufficient coupling of 36.7 dB was confirmed in this patient. In a Bland-Altman analysis of the intraoperative VSB-ABRs and coupling quality, the limits of agreement exceeded ± 10 dB, i.e., the maximum allowed difference considered as not clinically important but the variation was within the general precision of auditory brainstem responses to predict behavioral thresholds. Five outliers were identified. In two patients, the postoperative VSB-ABR thresholds were in agreement with the coupling quality, indicating a change of coupling before the postoperative testing. Conclusion The response thresholds recorded in this setup have the potential to predict the VSB coupling quality and optimize postoperative audiological results.

Purpose Aim of the study was to evaluate the surgical, clinical and audiological outcome of 32 implantations of the Bonebridge, a semi-implantable transcutaneous active bone conduction implant. Methods In a retrospective cohort study, we analyzed data for 32 implantations in 31 patients (one bilateral case; seven age < 16 years) with conductive or mixed hearing loss, malformations, after multiple ear surgery, or with single-sided deafness as contralateral routing of signal (CROS). Results Four implantations were done as CROS. Five cases were simultaneously planned with ear prosthesis anchors, and 23 implantations (72%) were planned through three-dimensional (3D) “virtual surgery.” In all 3D-planned cases, the implant could be placed as expected. For implant-related complications, rates were 12.5% for minor and 3.1% for major complications. Implantation significantly improved mean sound field thresholds from a preoperative 60 dB HL (SD 12) to 33 dB HL (SD 6) at 3 postoperative months and 34 dB HL (SD 6) at > 11 postoperative months (p < 0.0001). Word recognition score in quiet at 65 dB SPL improved from 11% (SD 20) preoperatively to 74% (SD 19) at 3 months and 83% (SD 15) at > 11 months (p < 0.0001). The speech reception threshold in noise improved from − 1.01 dB unaided to − 2.69 dB best-aided (p = 0.0018). Conclusion We found a clinically relevant audiological benefit with Bonebridge. To overcome anatomical challenges, we recommend preoperative 3D planning in small and hypoplastic mastoids, children, ear malformation, and simultaneous implantation of ear prosthesis anchors and after multiple ear surgery.

Objective: To predict and optimize hearing outcomes with a cochlear implant (CI) in patients with intracochlear schwannoma and neurofibromatosis type 2 (NF2). Patient: A patient with NF2 and bilateral deafness. Interventions: The intracochlear portion of a vestibular schwannoma was removed with a partial cochleoectomy. During the procedure, a CI was implanted. Main Outcome Measures: Perioperatively, electrically evoked auditory brainstem responses (eABRs) were recorded with a novel intracochlear, CI-evoked, broad band stimulus to support the decision to implant a CI. Results: We found positive eABR responses, with thresholds at around the 200 current level. The eV wave was discernible at all stimulated electrodes, with a prolonged latency of about 6.5 ms. The eIII wave was detected at electrodes 9 and 13, with a latency of 4.5 ms. The acoustic reflex was detectable at all stimulated electrodes. Subjective auditory perception could be achieved by stimulating 3 days after surgery. In open-set word recognition, the patient achieved 60% recognition of monosyllables after the first audio processor fitting and 100% 1 month later. Conclusions: After a partial cochleoectomy, this method may serve as a peri-operative, objective assessment of cochlear nerve integrity that could potentially impact the prediction of CI performance. Potential future applications might be assessments of cochlear nerve integrity in patients with inner ear malformations, radiologically suspected cochlear nerve deficiencies, and resected or irradiated spontaneous vestibular schwannomas or NF2.