Ipsilateral Cochlear Implantation After Cochlear Nerve Preserving Vestibular Schwannoma Surgery in Patients With Neurofibromatosis Type 2

Lloyd, Simon; Glynn, Fergal; Rutherford, Scott A.; King, Andrew; Mawman, Deborah; O’Driscoll, Martin; Evans, D. Gareth; Ramsden, R. T.; Freeman, Simon

doi:10.1097/mao.0000000000000185

Cited by 68 publications

(49 citation statements)

References 30 publications

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“…Cochlear implantation has been previously described for the hearing rehabilitation of patients with NF-2 and sporadic VS in the only or better hearing ear [Lustig et al, 2006;Odat et al, 2011;Carlson et al, 2012;Di Lella et al, 2013;Lloyd et al, 2014;Aristegui and Denia, 2015;Lassaletta et al, 2016]. However, little is known about their benefits in the presence of normal contralateral hearing after VS resection.…”

Section: Discussionmentioning

confidence: 99%

Vestibular Schwannoma Resection with Ipsilateral Simultaneous Cochlear Implantation in Patients with Normal Contralateral Hearing

et al. 2016

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Objective: To report the hearing results of cochlear implantation simultaneous to vestibular schwannoma (VS) resection by means of a translabyrinthine approach in patients with normal contralateral hearing. Methods: This was a prospective study including adults with sporadic VS. Tumors were resected by means of a modified translabyrinthine approach with preservation of the cochlear nerve. Results: A total of 13 patients underwent cochlear implantation. At 14 months, the mean pure-tone audiogram was 56 dB. The mean speech recognition was 80%. Cochlear implantation provides monaural and binaural benefits in all the conditions tested, including sound localization. Conclusions: Cochlear implantation can be safely performed simultaneously to VS resection with satisfactory hearing results provided that the cochlear nerve is anatomically intact.

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Section: Discussionmentioning

confidence: 99%

Vestibular Schwannoma Resection with Ipsilateral Simultaneous Cochlear Implantation in Patients with Normal Contralateral Hearing

et al. 2016

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“…Lloyd et al [33] have recently published results of this type of approach using either retrosigmoid or translabyrinthine surgery and have demonstrated that it is possible to gain significant benefit from a cochlear implant in the majority of patients. It seems that cochlear implantation alone in patients with profound hearing loss and stable tumours is a further option and has been shown to produce effective hearing rehabilitation with post implantation speech discrimination scores of around 60 % [34,35].…”

Section: Discussionmentioning

confidence: 97%

Progress of hearing loss in neurofibromatosis type 2: implications for future management

Kontorinis

Nichani²,

Freeman³

et al. 2014

Eur Arch Otorhinolaryngol

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The objective of this study was to describe changes in hearing over time in patients with neurofibromatosis type 2 (NF2) treated conservatively. A retrospective case review was conducted in a tertiary referral centre. Pure tone audiometry, speech discrimination scores, serviceable hearing (American Academy of Otolaryngology class A or B) and measurement of vestibular schwannoma (VS) size on magnetic resonance imaging were evaluated in 56 patients (89 ears) with NF2 with at least one conservatively managed VS. Over a mean follow-up period of 7 years (range 0.8-21 years) pure tone average thresholds increased gradually with a mean annual rate of 1.3 dB for the right ear (p = 0.0003) and 2 dB for the left ear (p = 0.0009). Speech discrimination scores dropped with an average annual rate of 1.3 and 0.34% in the right and left ear, respectively. Patients maintained serviceable hearing for an average of 7.6 years (range 2.7-19.3 years). The average annual VS growth was 0.4 mm without any correlation with hearing loss. There was a correlation between patients' age and pure tone threshold increase (p < 0.05 for both ears). In this selected population of patients with NF2, hearing threshold increases were very slow. In NF2 patients with indolently behaving tumours, serviceable hearing can be maintained for a significant length of time, making conservative management an attractive option.

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“…Most ABI users gained enhanced communication skills when combined with LR to an extent that was greater than the sum of the two individual skills. Subjectively these abilities are of value (7,8). In only a very small number of individuals was performance with the ABI comparable to that expected from a cochlear implant, most of whom achieve open-set speech understanding and high sentence scores even in NF2 (9).…”

Section: Discussionmentioning

confidence: 99%

Auditory Brainstem Implantation in Neurofibromatosis Type 2

Ramsden¹,

Freeman²,

Lloyd

et al. 2016

Otology &Amp; Neurotology

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Objective: To describe the experience of auditory brainstem implantation (ABI) in patients with Neurofibromatosis type 2 (NF2). Results: There were 50 primary ABI insertions in 49 patients, including 16 inserted at the time of first side tumor removal as a sleeper, and two revision repositionings which failed to improve outcome. Postoperatively three patients had cerebrospinal fluid leaks which did not require reoperation, one patient had meningitis, and eight patients suffered either temporary or permanent lower cranial nerve dysfunction. Twenty-nine patients became full time users; a further 12 patients became non-users. Three patients died while their device was inactive. Five patients retain serviceable contralateral hearing. Audiological open set testing of users showed means of: environmental sounds discrimination 51%; phoneme discrimination: with ABI alone 22%/lip reading (LR) 45%/ABI with LR 65%; sentence testing: with ABI alone 13%/LR 19%/ABI with LR 54%. Conclusions: The majority of patients with NF2 implanted with an ABI find the device a useful aid to communication in conjunction with LR and in recognizing common environmental sounds. A small proportion gain open set discrimination. Almost a third of patients may end up as non-users. There is probably an increased risk of postoperative lower cranial nerve dysfunction so careful preoperative assessment is advised.Key Words: Auditory brainstem implantBilateral deafness-Postoperative complications-SurgeryVestibular schwannoma.Otol Neurotol 37:xxx-xxx, 2016.The auditory brainstem implant (ABI) evolved from cochlear implant technology to rehabilitate those individuals with total bilateral deafness who are unsuitable for cochlear implantation because of non-functional cochlear nerves or unimplantable cochleas. The majority of candidates suffer from the genetic disorder neurofibromatosis type 2 (NF2) which causes bilateral vestibular schwannomas leading to deafness either by direct damage from the tumors themselves or from the surgery to remove them (1). The ABI stimulates the cochlear nucleus complex directly, which is readily accessible after vestibular schwannoma removal.The Manchester programme participated in the original European pilot study (2), and since then has routinely offered it to appropriate patients. This article reviews our experience in NF2 patients. MATERIAL AND METHODS PatientsPatients were included in the study if they met the Manchester criteria for NF2 disease (3), and had been implanted with an ABI and had continued rehabilitation by the Manchester team between 1994 and 2009.

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Ipsilateral Cochlear Implantation After Cochlear Nerve Preserving Vestibular Schwannoma Surgery in Patients With Neurofibromatosis Type 2

Cited by 68 publications

References 30 publications

Vestibular Schwannoma Resection with Ipsilateral Simultaneous Cochlear Implantation in Patients with Normal Contralateral Hearing

Vestibular Schwannoma Resection with Ipsilateral Simultaneous Cochlear Implantation in Patients with Normal Contralateral Hearing

Progress of hearing loss in neurofibromatosis type 2: implications for future management

Auditory Brainstem Implantation in Neurofibromatosis Type 2

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