Cochlear implant in a patient with neurofibromatosis type 2 undergoing radiotherapy

Pimentel, Patrícia Santos; Ramos, Danielle Seabra; Muniz, Lílian Ferreira; Leal, Mariana de Carvalho; Neto, Sílvio da Silva Caldas

doi:10.1016/j.bjorl.2015.04.004

Cited by 7 publications

(12 citation statements)

References 4 publications

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“…Tolisano et al cited at least 1 year of no tumor growth. 29 North et al suggested observation should occur for 2 years prior to implantation. 15 Our patients' observed tumors were stable on imaging for 7 (RUMC) and 12 (UCMC) years, respectively.…”

Section: Observation Prior To CImentioning

confidence: 99%

Ipsilateral Cochlear Implantation in the Presence of Observed and Irradiated Vestibular Schwannomas

Urban

Moore

Kwarta

et al. 2020

Ann Otol Rhinol Laryngol

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Objectives: Historically, eventual loss of cochlear nerve function has limited patients with neurofibromatosis type 2 (NF2) to auditory brainstem implants (ABI), which in general are less effective than modern cochlear implants (CI). Our objective is to evaluate hearing outcomes following ipsilateral cochlear implantation in patients with NF2 and irradiated vestibular schwannomas (VS), and sporadic VS that have been irradiated or observed. Methods: Multi-center retrospective analysis of ipsilateral cochlear implantation in the presence of observed and irradiated VS. MESH search in NCBI PubMed database between 1992 and 2019 for reported cases of cochlear implantation with unresected vestibular schwannoma. Results: Seven patients underwent ipsilateral cochlear implantation in the presence of observed or irradiated vestibular schwannomas. Four patients had sporadic tumors with severe-profound contralateral hearing loss caused by presbycusis/hereditary sensorineural hearing loss, and three patients with NF2 lost contralateral hearing after prior surgical resection. Prior to implantation, one VS was observed without growth for a period of 7 years and the others were treated with radiotherapy. Mean post-operative sentence score was 63.9% (range 48-91) at an average of 28 (range 2-84) months follow up. All patients in this cohort obtained open set speech perception. While analysis of the literature is limited by heterogenous data reporting, 85% of implants with observed schwannomas achieved some open set perception, and 67% of patients previously radiated schwannomas. Furthermore, blending literature outcomes for post implantation sentence testing in quiet without lip-reading show 59.0 ± 35% for patients with CI and observed tumors and 55.7 ± 35% for patients with radiated tumors, with both groups ranging 0 to 100%. Conclusion: This retrospective series and literature review highlight that hearing outcomes with CI for VS patients are superior to those achieved with ABI. However, important considerations including imaging, delayed hearing loss, and observation time cannot be ignored in this population.

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Section: Observation Prior To CImentioning

confidence: 99%

Ipsilateral Cochlear Implantation in the Presence of Observed and Irradiated Vestibular Schwannomas

Urban

Moore

Kwarta

et al. 2020

Ann Otol Rhinol Laryngol

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“…Twelve patients had previously undergone surgical resection of the contralateral VS, 10 - 12 , 14 , 16 , 20 , 22 of which one patient had received a contralateral auditory brainstem implantation (ABI). 20 Two patients had received GKS, 17 and 1 patient FSRT on the contralateral VS. 23 One patient had received a partial resection of the ipsilateral VS prior to irradiation and CI. 18 …”

Section: Resultsmentioning

confidence: 99%

“…Nine tumors received SRS, 9 , 14 , 15 , 18 10 tumors received GKS, 11 , 17 - 22 and 6 tumors received FSRT. 12 , 18 , 19 , 23 In 9 cases, type of radiation was unspecified or not mentioned. 10 , 16 , 18 Four studies reported radiation dosage.…”

Section: Resultsmentioning

confidence: 99%

“…Moderate HL was described for 11 patients. 9 , 11 , 12 , 14 , 15 , 21 - 23 Six patients included had moderate to severe HL. Of these, 2 patients scored 0% for Bamford–Kowal–Bench (BKB) test without lip reading, but 8% and 20%, respectively, with lip reading.…”

Section: Resultsmentioning

confidence: 99%

“…The CI model was reported in all but 8 patient cases across 4 studies. 10 , 14 , 19 , 23 The Cochlear Nucleus Freedom was the most encountered model used in 7 patients across 4 studies 12 , 16 , 18 , 22 ( Table 1 ). Cochlear Nucleus 512 was used in 4 patients, 15 , 18 and Nurotron CS-10A was used in 2 cases.…”

Section: Resultsmentioning

confidence: 99%

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Cochlear Implantation After Radiotherapy of Vestibular Schwannomas

et al. 2021

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Background and Objectives: Vestibular schwannomas (VS) frequently lead to ipsilateral sensorineural hearing loss (HL) as part of its natural history or as a result of treatment. Cochlear implantation represents a well-documented treatment of profound HL that cannot be treated adequately with a conventional hearing aid, thus being offered to selected VS patients. A functional cochlea and cochlear nerve are prerequisites for sound perception with a cochlear implant (CI). The potential impact of radiotherapy on these structures is thus an important issue for subsequent CI hearing outcomes. The objective of this article is to present a case and to review the existing literature on the outcomes of cochlear implantation in irradiated VS patients systematically. Methods: A systematic literature review using preferred reporting items for systematic reviews and meta-analyses was conducted. Medline was searched systematically. Papers reporting ipsilateral CI outcomes after radiotherapy of VS were included. Additionally, results of CI after stereotactic radiotherapy in a 54-year-old male with neurofibromatosis type 2 are presented. Results: A total of 14 papers (33 patients) fulfilled inclusion criteria. Moderate preoperative HL was found in 11 patients. Six had moderate to severe HL, whereas 16 had severe HL or total deafness. Postoperative hearing outcomes varied from poor in 27% of patients to excellent in 19%, with remaining cases lying in between (mean follow-up of 19 months). Most patients achieved improvement in hearing and quality of life. Conclusion: Despite variation in the degree of hearing outcome, CI after radiotherapy of VS appears to be effective in the majority of cases, as more than 70% of patients have good or excellent outcomes within 1-2 years post-implantation. Subjective benefits are considerable, even in cases with relatively poor objective outcome.

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Cochlear Implantation in Vestibular Schwannoma: A Systematic Literature Review

Tadokoro

Bartindale

El-Kouri

et al. 2021

J Neurol Surg B Skull Base

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Objective Ipsilateral cochlear implantation (CI) in vestibular schwannoma (VS) has been an emerging trend over the last two decades. We conducted the first systematic review of hearing outcomes comparing neurofibromatosis 2 (NF2) and sporadic VS undergoing CI. A comparison of the two populations and predictor of outcome was assessed. This is an update to a previously presented study. Data Sources Systemic data searches were performed in PubMed NCBI and Scopus by an academic librarian. No restrictions based on the year of publication were used. Study Selection Studies were selected if patients had a diagnosis of NF2 and a CI placed in the affected side with reports of hearing outcome. Two independent reviewers screened each abstract and full-text article. Data Extraction Studies were extracted at the patient level, and the assessment of quality and bias was evaluated according to the National Institutes of Health Quality Assessment Tool. Main Outcome Measures Outcome predictors were determined by using the chi-square test and Student's t-test. Results Overall, most CI recipients functioned in the high-to-intermediate performer category for both sporadic and NF2-related VS. Median AzBio (Arizona Biomedical Institute Sentence Test) was 72% (interquartile range [IQR]: 50) in NF2 patients and 70% (IQR: 7.25) in sporadic patients. Larger tumor size predicted a poorer final audiometric outcome. Conclusions Categorization of hearing outcome into superior performance and inferior performance based on sentence recognition revealed a generally good hearing outcome regardless of treatment or patient population. Select patients with sporadic and NF2 VS may benefit from CI.

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Cochlear implant in a patient with neurofibromatosis type 2 undergoing radiotherapy

Cited by 7 publications

References 4 publications

Ipsilateral Cochlear Implantation in the Presence of Observed and Irradiated Vestibular Schwannomas

Ipsilateral Cochlear Implantation in the Presence of Observed and Irradiated Vestibular Schwannomas

Cochlear Implantation After Radiotherapy of Vestibular Schwannomas

Cochlear Implantation in Vestibular Schwannoma: A Systematic Literature Review

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