Changing Management of Intravestibular Schwannomas in the Era of Cochlear Implantation for Single-Sided Deafness

Abstract

Objective Intralabyrinthine schwannomas (ILSs) are a rare cause of deafness. Patients with ILS confined to the semicircular canals and the vestibule (intravestibular schwannomas) are potential candidates for cochlear implantation for hearing rehabilitation, a new option for patients with unilateral hearing loss since the 2019 FDA approval of cochlear implant (CI) for single-sided deafness. In this report, we describe an evolving management approach for ILSs causing hearing loss. Patients Adults (≥18 years) who underwent simultaneous ILS resection and CI between January 2019 and June 2023 (n = 3). Intervention Transmastoid labyrinthectomy with simultaneous cochlear implantation. Main Outcome Measures Hearing performance with cochlear implantation measured as CNC Word Recognition scores and AzBio Sentence scores. Results Three patients with ILS confined to the semicircular canals and vestibule underwent simultaneous tumor resection via labyrinthectomy with CI placement. In all cases, complete tumor resection and full CI insertion were achieved. No patients experienced postoperative complications. Patients 1 and 2 underwent 6- and 9-month postactivation testing, respectively, with CNC scores 64% to 80% and AzBio 81% to 99% in the implanted ears. Patient 3 scored 0% on CNC and AzBio testing at 3 months and deferred her 6-month audiometry. Conclusions Patients with ILS confined to the vestibule and semicircular canals can be considered for simultaneous tumor resection and CI placement.