Cochlear Implant Outcomes Following Vestibular Schwannoma Resection: Systematic Review

Abstract

Objective: Hearing loss remains a significant morbidity for patients with vestibular schwannomas (VS). A growing number of reports suggest audibility with cochlear implantation following VS resection; however, there is little consensus on preferred timing and cochlear implant (CI) performance. Data Sources: A systematic literature search of the Ovid Medline, Embase, Scopus, and clinicaltrails.gov databases was performed on 9/7/2018. PRISMA reporting guidelines were followed. Study Selection: Included studies reported CI outcomes in an ear that underwent a VS resection. Untreated VSs, radiated VSs, and CIs in the contralateral ear were excluded. Data Extraction: Primary outcomes were daily CI use and attainment of open-set speech. Baseline tumor and patient characteristics were recorded. Subjects were divided into two groups: simultaneous CI placement with VS resection (Group 1) versus delayed CI placement after VS resection (Group 2). Data Synthesis: Twenty-nine articles with 93 patients met inclusion criteria. Most studies were poor quality due to their small, retrospective design. Group 1 had 46 patients, of whom 80.4% used their CI on a daily basis and 50.0% achieved open-set speech. Group 2 had 47 patients, of whom 87.2% used their CI on a daily basis and 59.6% achieved open-set speech. Group 2 had more NF2 patients and larger tumors. CI timing did not significantly impact outcomes. Conclusions: Audibility with CI after VS resection is feasible. Timing of CI placement (simultaneous versus delayed) did not significantly affect performance. Overall, 83.9% used their CI on a daily basis and 54.8% achieved open-set speech.

Early Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation

“…Audiologic outcomes were similar in patients undergoing simultaneous CI and delayed CI after translabyrinthine resection in a recent systematic review. 11 Although some of the patients in the current study had smaller tumors and good preoperative hearing, they preferred to undergo translabyrinthine surgical resection rather than observation or a hearing preservation approach. One patient specifically, given the option of a retrosigmoid approach, opted for translabyrinthine approach due to a family member with severe headaches after a similar surgery.…”

“…10 TL excision of a VS with simultaneous or sequential CI has also been reported recently with promising results; however, there is limited prospective data regarding simultaneous implantation. 11 The purpose of this study is to evaluate the early audiologic results of TL resection of a VS and simultaneous placement of a CI to expand the relatively limited evidence currently available for this procedure.…”

Current Understanding of Hearing Loss in Sporadic Vestibular Schwannomas: A Systematic Review

“…A recent systematic including 29 studies with 93 patients indicated that servable hearing with CI is feasible after VS surgery if the cochlear nerve is anatomically preserved ( 82 ). Among those patients, 83.9% used the CI device daily and 54.8% achieved open-set speech ( 82 ).…”

“…Cochlear implants (CI), as the most successful neural prosthesis, also play an important role in the hearing rehabilitation for SVS patients after surgery. CI can be placed either simultaneously with the resection of SVS or in a delayed manner, but the timing of this procedure seems not to influence overall hearing outcomes (80)(81)(82). A recent systematic including 29 studies with 93 patients indicated that servable hearing with CI is feasible after VS surgery if the cochlear nerve is anatomically preserved (82).…”

“…CI can be placed either simultaneously with the resection of SVS or in a delayed manner, but the timing of this procedure seems not to influence overall hearing outcomes (80)(81)(82). A recent systematic including 29 studies with 93 patients indicated that servable hearing with CI is feasible after VS surgery if the cochlear nerve is anatomically preserved (82). Among those patients, 83.9% used the CI device daily and 54.8% achieved open-set speech (82).…”