Hearing Restoration for Adults with Vestibular Schwannoma in the Only Hearing Ear: Ipsilateral or Contralateral Cochlear Implantation?

Huo, Zirong; Zhang, Zhihua; Huang, Qiangsheng; Yang, Jun; Wang, Zhaoyan; Li, Yun; Huang, Meiping; Wu, Hao

doi:10.1159/000451003

Cited by 11 publications

(8 citation statements)

References 20 publications

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“…Six of the studies report simultaneous VS resection and concomitant CI, 17 , 18 , 20 ,23–25 2 studies report a CI sequential to previous tumor resection 19 , 22 and 1 study reports CI in an ear with a tumor under observation. 21 In 3 papers, the THI is used for quantification of tinnitus, 21–23 2 papers use other measurement tools, 24 , 25 1 paper uses the Visual Analog Scale 19 and in the 3 remaining papers, the tinnitus change is only qualitatively reported. 17 , 18 , 20 In 6 papers, 17–20, 23 , 24 Cochlear implantation is reported to improve tinnitus burden and in 1 paper, 21 tinnitus is worse after CI.…”

Section: Resultsmentioning

confidence: 99%

Cochlear Implantation for Patients with a Vestibular Schwannoma: Effect on Tinnitus Handicap

West¹,

Bunne²,

Sass³

et al. 2022

Int Adv Otol

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Background: Tinnitus is a common symptom among individuals with a vestibular schwannoma. In recent years, cochlear implantation, often combined with tumor resection, is an increasingly used option in the management of these patients. The existing literature does not account well for the effect of treatment on tinnitus burden. Thus, this paper reports the effect of cochlear implantation on tinnitus in a cohort of vestibular schwannoma patients. Methods: Individuals with vestibular schwannoma undergoing cochlear implantation were retrospectively reviewed for tinnitus burden, as evaluated by the Tinnitus Handicap Inventory, administered before and after implantation. The outcome measures were total Tinnitus Handicap Inventory score and scores from each of the Tinnitus Handicap Inventory subdomains (functional, emotional, and catastrophic). In addition, the existing literature on tinnitus in cochlear implanted vestibular schwannoma patients was reviewed. Results: Tumor management consisted of simultaneous resection (77%), previous resection (9%), observation (9%) and radiation (5%). Complete Tinnitus Handicap Inventory evaluation was available for 17 patients. After implantation, the median THI total changed from 18 to 10 ( P = .0006), the subdomain THI functional from 10 to 3 ( P = .006), the THI emotional from 3 to 0 ( P = .023) and the THI catastrophic from 6 to 1 ( P = .004). In the scarcely reported tinnitus outcomes in the literature, most but not all cases experienced a decrease in tinnitus. Conclusions: The tinnitus burden is significantly reduced by cochlear implantation in individuals with a vestibular schwannoma. This agrees with findings for other etiologies indicating cochlear implantation and supports the eligibility for hearing rehabilitation with a cochlear implant for this specific group of patients.

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Section: Resultsmentioning

confidence: 99%

Cochlear Implantation for Patients with a Vestibular Schwannoma: Effect on Tinnitus Handicap

West¹,

Bunne²,

Sass³

et al. 2022

Int Adv Otol

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“…4 Since that time, additional data have emerged supporting safe and effective cochlear implantation in patients with unresected vestibular schwannomas following treatment with radiation or a period of observation of small, stable schwannomas. 2,3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Our study aims to compile the current data regarding hearing outcomes for cochlear implantation in ears with non-operated tumors and also add to the recent growing body of evidence with this multi-center series.…”

Section: Introductionmentioning

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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“…Altogether considering our series with previous reports, 57 CIs and five ABIs were implanted to rehabilitate hearing in 58 sporadic VSs in the only hearing ear during the last 28‐year period (Table ) . Most of the patients have been operated on mainly by TL, apart from nine patients whose hearing was restored by CI without VS surgery (present study) . CI was implanted in the contralateral ear or in the ipsilateral VS ear in 35 and 22 cases, respectively.…”

Section: Discussionmentioning

confidence: 80%

“…Management of sporadic vestibular schwannoma (VS) in the only hearing ear represents a difficult challenge in neuro‐otology . During the last two decades, the number of VS diagnosed has increased dramatically, mainly due to the wide diffusion and easy access to magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

Management of sporadic vestibular schwannoma with contralateral nonserviceable hearing

et al. 2019

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Objectives/Hypothesis: To outline a possible decision-making process for sporadic vestibular schwannoma (VS) with contralateral nonserviceable hearing at diagnosis.Study Design: Retrospective case series. Methods: Diagnosed VS was studied in a tertiary referral center from 1995 to 2013. Results: Twenty-eight patients were included, with a mean follow-up of 6.9 years (range = 0.5-20 years). Ten were stage 1, 10 were stage 2, five were stage 3, and three were stage 4. Ipsilateral hearing levels were A (n = 3), B (n = 10), C (n = 7) and D (n = 8) American Academy of Otolaryngology-Head and Neck Surgery classification. Contralateral hearing levels were C (n = 11) and D (n = 17). Initial VS management included surveillance (n = 12) or surgery (n = 16), and four patients were later treated with surgery (n = 3) or stereotactic irradiation (n = 1). Hearing was improved by hearing aids and/or etiological treatment (n = 8), restored by contralateral (n = 15) or ipsilateral (n = 4) cochlear implants (CIs), or ipsilateral auditory brainstem implants (ABIs) (n = 3). Finally, 18 CIs were active daily; 14 of them presented high or moderate benefit with mean open-set dissyllabic word scores (WRS) of 58.1% and sentence recognition scores (SRS) of 69.7%, but only one ABI was still active (WRS of 70% and SRS of 87% with lip reading).Conclusions: When early removal of VS was not necessary, contralateral CI or etiological treatment for hearing loss might be recommended initially. Ipsilateral CI is proposed, whereas VS should be operated on if previous hearing restoration was not successful. ABI should be reserved for the rare cases where a contralateral CI could not be implanted or the cochlear nerve was sectioned during VS removal.

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Hearing Restoration for Adults with Vestibular Schwannoma in the Only Hearing Ear: Ipsilateral or Contralateral Cochlear Implantation?

Cited by 11 publications

References 20 publications

Cochlear Implantation for Patients with a Vestibular Schwannoma: Effect on Tinnitus Handicap

Cochlear Implantation for Patients with a Vestibular Schwannoma: Effect on Tinnitus Handicap

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

Management of sporadic vestibular schwannoma with contralateral nonserviceable hearing

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