Abstract
IntroductionHearing rehabilitation with cochlear implants has attracted increasing interest also for patients with cochleovestibular schwannoma. The authors report their experience with the surgical management of tumors with rare transmodiolar or transmacular extension and outcomes after cochlear implantation (CI).MethodsThis retrospective case series included nine patients with either primary intralabyrinthine tumors or secondary invasion of the inner ear from the internal auditory canal. The primary endpoint with CI, performed in six patients, was word recognition score at 65 dB SPL (sound pressure level). Secondary endpoints were intra- and postoperative electrophysiological parameters, impedance measures, the presence of a wave V in the electrically evoked (via the CI) auditory brainstem responses, the specifics of postoperative CI programming, and adverse events.ResultsHearing rehabilitation with CI in cases of transmodiolar tumor growth could be achieved only with incomplete tumor removal, whereas tumors with transmacular growth could be completely removed. All six patients with CI had good word recognition scores for numbers in quiet conditions (80–100% at 65 dB SPL, not later than 6 to 12 months post CI activation). Four of these six patients achieved good to very good results for monosyllabic words within 1–36 months (65–85% at 65 dB SPL). The two other patients, however, had low scores for monosyllables at 6 months (25 and 15% at 65 dB SPL, respectively) with worsening of results thereafter.ConclusionsCochleovestibular schwannomas with transmodiolar and transmacular extension represent a rare entity with specific management requirements. Hearing rehabilitation with CI is a principal option in these patients.Video onlineThe online version of this article (10.1007/s00106-020-00919-9) includes a video (2D and 3D versions) of the described surgical technique. Article and supplementary material are available at www.springermedizin.de. Please enter the title of the article in the search field, the supplementary material can be found under “Ergänzende Inhalte”.
Highlights
Cochleovestibular schwannomas are benign tumors of the eighth cranial nerve with an incidence of approximately 3.4/105 [41]
All patients were informed of the different management options: 1) wait and test and scan, 2) radiotherapy, 3) complete or incomplete tumor removal, and 4) if possible, hearing rehabilitation with cochlear implantation (CI)
Patient 3 was observed until the hearing threshold deteriorated, a hear
Summary
Cochleovestibular schwannomas are benign tumors of the eighth cranial nerve with an incidence of approximately 3.4/105 [41]. For ILS limited to the inner ear, surprisingly good results with CI with respect to speech understanding have been reported, despite substantial cochlear trauma from the surgical tumor removal [2, 35, 36, 38]. Hearing rehabilitation with cochlear implants has attracted increasing interest for patients with cochleovestibular schwannoma The authors report their experience with the surgical management of tumors with rare transmodiolar or transmacular extension and outcomes after cochlear implantation (CI). This retrospective case series included nine patients with either primary intralabyrinthine tumors or secondary invasion of the inner ear from the internal auditory canal. Hearing rehabilitation with CI is a principal option in these patients
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