Early Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation

Abstract

Objectives/Hypothesis: Hearing rehabilitation after translabyrinthine resection of a vestibular schwannoma (VS) has largely been based on the transfer of acoustic stimulus to the contralateral ear, typically through a contralateral routing of signal hearing aid or bone-anchored hearing aid (BAHA). Cochlear implant, either as a subsequent surgery or simultaneously, has become a more common treatment option; however, there is still relatively limited data available on its success. The purpose of this study is to evaluate the early outcomes of simultaneous cochlear implantation in patients with sporadic VS undergoing translabyrinthine resection.Study Design: Prospective, nonrandomized study. Methods: A prospective study of nonrandomized patients was completed at a tertiary care neurotology center. Audiologic outcomes, primarily based on AzBIO in quiet and background noise, as well as consonant-nucleus-consonant (CNC) testing of the affected ears were utilized. Tinnitus, dizziness, and spatial hearing questionnaries were also completed. Audiologic outcomes and questionnaires were compared between the pre-and postoperative groups.Results: Ten patients were included in the study with 3 month follow-up data. There was statistically significant improvement in AzBO with +10 and +5 signal to noise ratio and in quiet, as well as in CNC testing (P < .05). There was a significant improvement in Tinnitus Handicap Inventory between the two groups.Conclusions: Simultaneous cochlear implantation is a viable treatment for hearing loss after translabyrinthine approach to VS. These patients have improved hearing in background noise and tinnitus compared to their preoperative state. Further prognostic data are required to determine which patients are the best candidates.

Early Translabyrinthine Surgery for Small- and Medium-Sized Vestibular Schwannomas: Consecutive Cohort Analysis of Outcomes

“…Debate on treatment of small sporadic VS seems destined to continue as the lack of correct clinical studies and the inconclusive observational studies make it difficult to provide the patient with high-level evidence regarding the best clinical outcome with observation or active strategies (30). The opportunity to combine TLAB surgery with a cochlear implant has been recently investigated by several authors (31–34), and might become a factor in favor of proactive surgery . Other surgical approaches as retrosigmoid (2) and middle cranial fossa (35) are in principle hearing-sparing approaches and need to be considered as alternatives to TLAB when there are chances for hearing preservation (2).…”

Hearing Preservation Microsurgery in Vestibular Schwannomas: Worth Attempting in “Larger” Tumors?

“…Recent data, both from the adult single-sided deafness literature and within the VS population, indicate that cochlear implantation may ameliorate many of these deficits by reinstating binaural cues. 6,7,9,10 As a requisite for cochlear implantation in the VS population, the cochlear nerve must be anatomically intact and sufficiently healthy to transmit an electrical signal, and the cochlea must be largely patent for electrode placement. Implantation in this population is particularly appealing for patients with neurofibromatosis type 2 or contralateral hearing loss from unrelated factors.…”

“…Patients with unilateral hearing loss from VS often experience impaired sound localization, difficulty with speech understanding in noise, and tinnitus. Recent data, both from the adult single‐sided deafness literature and within the VS population, indicate that cochlear implantation may ameliorate many of these deficits by reinstating binaural cues 6,7,9,10 . As a requisite for cochlear implantation in the VS population, the cochlear nerve must be anatomically intact and sufficiently healthy to transmit an electrical signal, and the cochlea must be largely patent for electrode placement.…”

“…Most recently, cochlear implantation has emerged as a viable rehabilitative option for select patients with VS, potentially offering restitution of ipsilateral hearing. [6][7][8][9][10] Tumor size has been identified as a primary predictor of successful hearing preservation following microsurgical resection. [11][12][13][14][15][16] Based on prior data suggesting a low likelihood of functional hearing preservation with medium-tolarge sized VS, some have recommended forgoing attempts at hearing preservation once a VS reaches a certain size threshold (e.g., 15 mm cerebellopontine angle [CPA] dimension), instead preferring a translabyrinthine (TL) approach to reduce potential morbidity.…”

“…The importance of hearing preservation is further magnified in patients with existing contralateral hearing loss. Most recently, cochlear implantation has emerged as a viable rehabilitative option for select patients with VS, potentially offering restitution of ipsilateral hearing 6–10 …”