Cochlear implantation: an effective modality for hearing restoration following vestibular schwannoma resection

Abstract

Purpose of reviewPreservation of hearing is one of the tenets of vestibular schwannoma management. In recent years, cochlear implants have been employed with increasing use in patients who have suffered profound sensorineural hearing loss due to the natural history of vestibular schwannoma or due to injury to neurovascular anatomy at time of surgical resection. Recent findingsCochlear implantation has been found to be an effective modality for hearing restoration following vestibular schwannoma. Simultaneous cochlear implantation has been employed by an increased number of centers around the world and has been shown to provide restoration of open set speech perception and return of binaural hearing. Ongoing use of electrically evoked auditory brainstem response (ABR) has improved our detection of viable cochlear nerves and provided insight into those who would benefit from this procedure. Finally, minimally invasive approaches to the internal auditory canal and intralabyrinthine tumors have been described. These methods frequently employ simultaneous cochlear implantation and have emphasized that hearing preservation remains possible with surgical excision despite the location of the tumor. SummaryCochlear implantation is an effective modality for hearing restoration following vestibular schwannoma excision.

Brazilian Society of Otology task force – Vestibular Schwannoma ‒ evaluation and treatment

“…The CI is considered an option in cases where there is anatomical and functional preservation of the cochlear nerve, since CI results can be superior to those of the Auditory Brainstem Implant (ABI), with less morbidity. 127 , 309 Preservation of the cochlear nerve and improved CI response have been reported for tumors of up to 2 cm. 307 , 310 , 311 The CI has been used in “wait and scan” patients with VS who showed growth stability in the last2 to 3 years 310 , 312 , 313 ; in patients undergoing microsurgery with a hearing preservation technique such as the MF, RLB, or RS that evolves with hearing loss 305 , 310 or with the TLB approach, 300 , 306 either simultaneously or sequentially; and in patients undergoing radiosurgery or radiotherapy.…”

“…The use of electrically eABR has been shown to be effective in the intraoperative assessment of cochlear nerve function after VS resection, assisting in the selection of patients who may benefit from a CI. 306 , 309 …”

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

“…Previous studies (10)(11)(12) on vestibular schwannomas demonstrated benefit with CI placement after resection; however, these patients had tumors at the cerebellopontine angle. Literature regarding resection and CI for ILS remains limited, and studies focus on the most common subtype, intracochlear ILS (13).…”

Aktuelle Trends und Entwicklungen bei der Cochlea-Implantat-Versorgung

“…Wie die CI-EBERA, ist eine ANTS-EBERA bspw. für das Monitoring bei einer Tumorresektion und geplanter Cochleaimplantation in der gleichen Sitzung geeignet, gerade wenn mangels Restgehör keine akustische BERA möglich ist [20,25,88].…”