1
|
Khawaja MA, AlRamahi M, Hashlamoun M, Adwan AK. Successful Cochlear Implantation for Intracochlear Fibrosis. Cureus 2023; 15:e43042. [PMID: 37554374 PMCID: PMC10405754 DOI: 10.7759/cureus.43042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 08/10/2023] Open
Abstract
Intracochlear fibrosis is a rare disorder that can lead to hearing loss and make cochlear implantation challenging. The etiology of intracochlear fibrosis is diverse, including infections, inflammation, and past surgical procedures. The condition causes ossification and scar tissue growth within the cochlea, leading to progressive obstruction of the cochlear turn. High-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) are sensitive diagnostic modalities for fibrosis and ossification. There is a paucity of information in the literature regarding cochlear implantation during the fibrotic stage. This case report discussed the presentation, diagnosis, and surgical management of intracochlear fibrosis in a patient with a history of sudden and severe hearing loss. A 44-year-old female patient with a 20-year history of sudden profound sensorineural hearing loss (SNHL) in both ears was successfully treated with cochlear implantation. Thorough preoperative planning for cochlear implantation, including HRCT and MRI cochlear protocol, is crucial for identifying intracochlear fibrosis, which can be missed on routine audiometry. She underwent a surgery for right cochlear implantation using postauricular approach. Drilling was done to the round window niche, and we removed an abnormal, chalky white bone we encountered by continuing to drill this abnormal bone following the scale tympani until we identified the opening of the scala tympani, then we inserted the cochlear implant device. She was doing well on the subsequent post-operative follow-up. Intracochlear fibrosis treatment with cochlear implantation has proven successful in several studies. Audiologic outcomes vary with time to implantation, so an early attempt should be made for cochlear implantation. Follow-up is important to monitor auditory outcomes.
Collapse
Affiliation(s)
- Mustafa A Khawaja
- General Practice, School of Medicine, Al-Quds University, Jerusalem, PSE
| | | | | | - Adel K Adwan
- Otorhinolaryngology, School of Medicine, Al-Quds University, Jerusalem, PSE
| |
Collapse
|
2
|
Yao L, Wang B, Lu F, He X, Lu G, Zhang S. Facial nerve in skullbase tumors: imaging and clinical relevance. Eur J Med Res 2023; 28:121. [PMID: 36918971 PMCID: PMC10012458 DOI: 10.1186/s40001-023-01078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
Facial nerve, the 7th cranial nerve, is a mixed nerve composed of sensory and motor fibers, and its main branch is situated in the cerebellopontine angle. Facial nerve dysfunction is a debilitating phenomenon that can occur in skullbase tumors and Bell's pals. Recovery of the facial nerve dysfunction after surgery for skullbase tumors can be disappointing, but is usually favorable in Bell's palsy. Advances in magnetic resonance imaging (MRI) allow to visualize the facial nerve and its course in the cerebellopontine angle, also when a large tumor is present and compresses the nerve. Here, we describe the anatomical, neurochemical and clinical aspects of the facial nerve and highlight the recent progress in visualizing the facial nerve with MRI.
Collapse
Affiliation(s)
- Longping Yao
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.,Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Baoyan Wang
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Fengfei Lu
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Xiaozheng He
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Guohui Lu
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Shizhong Zhang
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| |
Collapse
|
3
|
Doerfer KW, Fritz CG, Porps SL, Hong RS, Jacob JT, Babu SC. Twelve-Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation. Otolaryngol Head Neck Surg 2023. [PMID: 36939583 DOI: 10.1002/ohn.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Audiometric outcomes at 12 months following simultaneous translabyrinthine (TL) resection of vestibular schwannoma (VS) and cochlear implantation (CI). STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. METHODS Adult patients undergoing TL resection of sporadic, unilateral VS ≤ 2 cm were prospectively enrolled. Preoperative testing included binaural AZBio in noise and quiet and unilateral Consonant-Nucleus-Consonant (CNC). Tinnitus Handicap Index (THI) and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires were also completed. Patients underwent TL resection with simultaneous CI. The preoperative test battery was repeated at 1, 3, 6, and 12 months after activation. Statistical analysis was performed to characterize short-term outcomes (preoperative to 3 months), longer-term outcomes (3-12 months), and overall changes during the preoperative to 12-month period. RESULTS AZBio, CNC, and THI improved at 3 months with no significant changes thereafter and showed durable improvement at 12 months compared to preoperative testing. While SSQ did not improve at 12 months, a subset of patients showed either recovery or improvement of SSQ-spatial subscores. Patients with cerebellopontine angle tumors had poorer performance, although the impact of tumor size and location could not be deduced based on the small sample size. CONCLUSION Patients undergoing simultaneous CI and TL resection of VS had durable improvements in speech perception and tinnitus severity 12 months following surgery. Subjective improvements in localization were not observed. Additional studies are needed to determine which VS patients are optimal candidates for CI.
Collapse
Affiliation(s)
- Karl W Doerfer
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christian G Fritz
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Sandra L Porps
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Robert S Hong
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Jeffrey T Jacob
- Division of Skull Base Surgery, Michigan Head and Spine Institute, Southfield, Michigan, USA
| | - Seilesh C Babu
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| |
Collapse
|
4
|
Tadokoro K, Bartindale MR, El-Kouri N, Moore D, Britt C, Kircher M. Cochlear Implantation in Vestibular Schwannoma: A Systematic Literature Review. J Neurol Surg B Skull Base 2021; 82:643-651. [PMID: 34745832 DOI: 10.1055/s-0040-1715606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/22/2020] [Indexed: 01/21/2023] Open
Abstract
Objective Ipsilateral cochlear implantation (CI) in vestibular schwannoma (VS) has been an emerging trend over the last two decades. We conducted the first systematic review of hearing outcomes comparing neurofibromatosis 2 (NF2) and sporadic VS undergoing CI. A comparison of the two populations and predictor of outcome was assessed. This is an update to a previously presented study. Data Sources Systemic data searches were performed in PubMed NCBI and Scopus by an academic librarian. No restrictions based on the year of publication were used. Study Selection Studies were selected if patients had a diagnosis of NF2 and a CI placed in the affected side with reports of hearing outcome. Two independent reviewers screened each abstract and full-text article. Data Extraction Studies were extracted at the patient level, and the assessment of quality and bias was evaluated according to the National Institutes of Health Quality Assessment Tool. Main Outcome Measures Outcome predictors were determined by using the chi-square test and Student's t -test. Results Overall, most CI recipients functioned in the high-to-intermediate performer category for both sporadic and NF2-related VS. Median AzBio (Arizona Biomedical Institute Sentence Test) was 72% (interquartile range [IQR]: 50) in NF2 patients and 70% (IQR: 7.25) in sporadic patients. Larger tumor size predicted a poorer final audiometric outcome. Conclusions Categorization of hearing outcome into superior performance and inferior performance based on sentence recognition revealed a generally good hearing outcome regardless of treatment or patient population. Select patients with sporadic and NF2 VS may benefit from CI.
Collapse
Affiliation(s)
- Kent Tadokoro
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| | | | - Nadeem El-Kouri
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Dennis Moore
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Christopher Britt
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Matthew Kircher
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| |
Collapse
|
5
|
Neuromonitoring of the cochlear nerve during vestibular schwannoma resection and simultaneous cochlear implantation. HNO 2021; 69:82-87. [PMID: 34019139 DOI: 10.1007/s00106-021-00997-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 12/26/2022]
Abstract
Vestibular schwannomas (VS) are benign tumors that originate from the nerve sheath of one of the two vestibular nerves. VS can have a severe impact on everyday life of the patient and may lead to symptoms such as vertigo, hearing loss (e.g., as sudden deafness), deafness, and tinnitus. Treatment concepts include observational waiting with regular imaging control ("wait and scan"), radiotherapy, or surgical resection. Depending on the size of the tumor and status of functional hearing, the surgical approach may be retrosigmoidal, transtemporal, retrolabyrinthine, or translabyrinthine. The translabyrinthine approach always results in complete deafness due to opening of the bony labyrinth. If the nerve structure of the cochlear nerve is preserved, hearing rehabilitation with a cochlear implant (CI) may be successful. In this article the surgical technique for microsurgical resection of VS using a translabyrinthine approach with simultaneous cochlear implantation under intraoperative monitoring of the cochlear nerve by electrical stimulation is presented.
Collapse
|
6
|
Conway RM, Tu NC, Sioshansi PC, Porps SL, Schutt CA, Hong RS, Jacob JT, Babu SC. Early Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation. Laryngoscope 2021; 131:E2312-E2317. [PMID: 33851722 DOI: 10.1002/lary.29436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 01/21/2023]
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. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2312-E2317, 2021.
Collapse
Affiliation(s)
- Robert M Conway
- Department of Otolaryngology-Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, Michigan, USA
| | - Nathan C Tu
- Michigan Ear Institute, Farmington Hills, Michigan, USA
| | | | | | | | - Robert S Hong
- Michigan Ear Institute, Farmington Hills, Michigan, USA
| | | | | |
Collapse
|
7
|
[Neuromonitoring of the cochlear nerve during vestibular schwannoma resection and simultaneous cochlear implantation. German version]. HNO 2021; 69:1002-1008. [PMID: 33730246 DOI: 10.1007/s00106-021-00996-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 01/02/2023]
Abstract
Vestibular schwannomas (VS) are benign tumors that originate from the nerve sheath of one of the two vestibular nerves. VS can have a severe impact on everyday life of the patient and may lead to symptoms such as vertigo, hearing loss (e.g., as sudden deafness), deafness, and tinnitus. Treatment concepts include observational waiting with regular imaging control ("wait and scan"), radiotherapy, or surgical resection. Depending on the size of the tumor and status of functional hearing, the surgical approach may be retrosigmoidal, transtemporal, retrolabyrinthine, or translabyrinthine. The translabyrinthine approach always results in complete deafness due to opening of the bony labyrinth. If the nerve structure of the cochlear nerve is preserved, hearing rehabilitation with a cochlear implant (CI) may be successful. In this article the surgical technique for microsurgical resection of VS using a translabyrinthine approach with simultaneous cochlear implantation under intraoperative monitoring of the cochlear nerve by electrical stimulation is presented.
Collapse
|
8
|
Talas DÜ, Beger O, Vayisoğlu Y, Hamzaoğlu V, Özalp H, Çakır S, Dağtekin A, Bağdatoğlu C. Cochleo-facial corridor to the vestibule and fundus of the internal auditory canal through oval window: a minimal invasive and cochlea sparing approach. Eur Arch Otorhinolaryngol 2021; 279:627-637. [PMID: 33595698 DOI: 10.1007/s00405-021-06680-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This cadaveric work aimed to test the effectiveness of a modified surgical corridor (ExpTSA: expanded transcanal supracochlear approach) developed for anatomic cochlear preservation in selected vestibular schwannoma patients necessitating to perform cochlear implantation for appropriate cases to achieve the best outcome. METHODS The ears of 10 cadavers (at mean age 75.70 ± 13.75 years, range 45-92 years) were dissected from the external auditory canal (EAC) to the internal auditory canal by ExpTSA under the guidance of a microscope and endoscope. All stages of the surgical process were recorded step by step and evaluated morphometrically. RESULTS The vestibular base was successfully reached in all ears without damaging the cochlear morphology and facial nerve. The vestibular base was 23.33 ± 2.02 mm away from the entrance (external orifice) and 10.26 ± 1.33 mm from the exit (internal orifice) of EAC. The oval window and vestibular base were measured to be 2.94 ± 1.05 mm and 5.87 ± 1.24 mm deep from the facial nerve, respectively. The normal areas of the oval window, the exit and entrance of EAC were found as 2.90 ± 0.81 mm2, 42.52 ± 13.66 mm2, and 110.73 ± 25.32 mm2, respectively. After ExpTSA procedure, the areas of the oval window (11.04 ± 2.83 mm2), the exit (122.45 ± 20.41 mm2) and entrance (167.49 ± 30.94 mm2) of EAC were expanded approximately 280%, 188%, and 50%, respectively. CONCLUSION The ExpTSA may be performed for accessing to the vestibule and fundus of IAC for tumor removal of intravestibular schwannoma patients (with or without fundus involvement) with unserviceable hearing, preserving the cochlear morphology.
Collapse
Affiliation(s)
- Derya Ümit Talas
- Department of Otorhinolaryngology, Faculty of Medicine, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey.
| | - Orhan Beger
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Faculty of Medicine, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey
| | - Vural Hamzaoğlu
- Department of Neurosurgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Hakan Özalp
- Department of Neurosurgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Salim Çakır
- Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ahmet Dağtekin
- Department of Neurosurgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Celal Bağdatoğlu
- Department of Neurosurgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| |
Collapse
|
9
|
Cochlear Implant Outcomes Following Vestibular Schwannoma Resection: Systematic Review. Otol Neurotol 2020; 41:1190-1197. [DOI: 10.1097/mao.0000000000002784] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
10
|
Dahm V, Auinger AB, Honeder C, Riss D, Landegger LD, Moser G, Matula C, Arnoldner C. Simultaneous Vestibular Schwannoma Resection and Cochlear Implantation Using Electrically Evoked Auditory Brainstem Response Audiometry for Decision-making. Otol Neurotol 2020; 41:1266-1273. [DOI: 10.1097/mao.0000000000002747] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
MRI surveillance following concurrent cochlear implantation in cases of vestibular schwannoma resection. Am J Otolaryngol 2020; 41:102518. [PMID: 32451290 DOI: 10.1016/j.amjoto.2020.102518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cochlear nerve preserving translabyrinthine vestibular schwannoma (VS) resection enables concurrent cochlear implantation. Implantation in patients with VS raises important concerns including the ability to undergo postoperative magnetic resonance imaging (MRI) monitoring of residual tumor growth or tumor recurrence, specifically with a retained magnet. We aim to assess the feasibility of MRI monitoring and the impact on image quality with retained cochlear implant (CI) magnets. METHODS Retrospective review of post-operative head MRI scans in CI recipients with a retained CI magnet, after cochlear nerve preserving translabyrinthine excision of VS. The ability to visualize the ipsilateral and contralateral internal auditory canal (IAC) and cerebellopontine angle (CPA) were assessed. RESULTS A total of eight surveillance head MRI were performed in six patients. In one case, in which the receiver was positioned lower, the view of the ipsilateral IAC and CPA was distorted. In all other cases, the views of both the ipsilateral and contralateral IAC and CPA were overall unimpaired. DISCUSSION Imaging artifact only very rarely impedes adequate visualization of the ipsilateral IAC or CPA in CI recipients. In anticipation of the need for further IAC and CPA imaging, it would be advisable to place the receiver in an exaggerated superior-posterior position to further decrease obscuring artifact. Thus, serial monitoring of VS tumors can be performed safely with preservation of image quality with a retained receiver magnet. CONCLUSIONS When placing the CI receiver-stimulator farther posterior-superiorly, excellent visualization of the IAC and CPA can be accomplished without significantly impairing the image quality.
Collapse
|
12
|
Rubini A, Bianconi L, Patel N, Marchioni D. Transcanal infrapromontorial approach for internal auditory canal surgery and cochlear implantation. Eur Arch Otorhinolaryngol 2020; 277:1053-1060. [DOI: 10.1007/s00405-020-05821-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
|
13
|
Sporadic and NF2-associated vestibular schwannoma surgery and simultaneous cochlear implantation: a comparative systematic review. Eur Arch Otorhinolaryngol 2019; 277:333-342. [DOI: 10.1007/s00405-019-05741-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/24/2019] [Indexed: 01/11/2023]
|
14
|
Jia H, Nguyen Y, De Seta D, Hochet B, Smail M, Bernardeschi D, Wu H, Mosnier I, Kalamarides M, Sterkers O. Management of sporadic vestibular schwannoma with contralateral nonserviceable hearing. Laryngoscope 2019; 130:E407-E415. [PMID: 31643090 DOI: 10.1002/lary.28369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/20/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022]
Abstract
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. LEVEL OF EVIDENCE 3 Laryngoscope, 130:E407-E415, 2020.
Collapse
Affiliation(s)
- Huan Jia
- Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yann Nguyen
- Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France.,Inserm "Minimally Invasive Robot-Based Hearing Rehabilitation", Sorbonne University, Paris, France
| | - Daniele De Seta
- Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France.,Inserm "Minimally Invasive Robot-Based Hearing Rehabilitation", Sorbonne University, Paris, France
| | - Baptiste Hochet
- Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France.,Inserm "Minimally Invasive Robot-Based Hearing Rehabilitation", Sorbonne University, Paris, France
| | - Mustapha Smail
- Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France.,Inserm "Minimally Invasive Robot-Based Hearing Rehabilitation", Sorbonne University, Paris, France
| | - Daniele Bernardeschi
- Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France.,Inserm "Minimally Invasive Robot-Based Hearing Rehabilitation", Sorbonne University, Paris, France
| | - Hao Wu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Isabelle Mosnier
- Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France.,Inserm "Minimally Invasive Robot-Based Hearing Rehabilitation", Sorbonne University, Paris, France
| | - Michel Kalamarides
- Neurosurgery Department, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France
| | - Olivier Sterkers
- Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France.,Inserm "Minimally Invasive Robot-Based Hearing Rehabilitation", Sorbonne University, Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
15
|
Zeitler DM, Dorman MF. Cochlear Implantation for Single-Sided Deafness: A New Treatment Paradigm. J Neurol Surg B Skull Base 2019; 80:178-186. [PMID: 30931226 DOI: 10.1055/s-0038-1677482] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/05/2018] [Indexed: 12/30/2022] Open
Abstract
Unilateral severe-to-profound sensorineural hearing loss (SNHL), also known as single sided deafness (SSD), is a problem that affects both children and adults, and can have severe and detrimental effects on multiple aspects of life including music appreciation, speech understanding in noise, speech and language acquisition, performance in the classroom and/or the workplace, and quality of life. Additionally, the loss of binaural hearing in SSD patients affects those processes that rely on two functional ears including sound localization, binaural squelch and summation, and the head shadow effect. Over the last decade, there has been increasing interest in cochlear implantation for SSD to restore binaural hearing. Early data are promising that cochlear implantation for SSD can help to restore binaural functionality, improve quality of life, and may faciliate reversal of neuroplasticity related to auditory deprivation in the pediatric population. Additionally, this new patient population has allowed researchers the opportunity to investigate the age-old question "what does a cochlear implant (CI) sound like?."
Collapse
Affiliation(s)
- Daniel M Zeitler
- Listen for Life Center, Department of Otolaryngology/HNS, Virginia Mason Medical Center Seattle, Washington, United States.,Department of Otolarygology/HNS, Clinical Faculty, University of Washington, Seattle, Washington, United States
| | - Michael F Dorman
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, United States
| |
Collapse
|
16
|
Thompson NJ, O'Connell BP, Brown KD. Translabyrinthine Excision of Vestibular Schwannoma with Concurrent Cochlear Implantation: Systematic Review. J Neurol Surg B Skull Base 2019; 80:187-195. [PMID: 30931227 DOI: 10.1055/s-0038-1677491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 12/05/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives Hearing rehabilitation is an important management aspect of patients undergoing excision of vestibular schwannomas. Studies have shown cochlear implantation (CI) is possible at the time of tumor excision via a translabyrinthine approach. Primary objectives of this report are (1) to review prospective studies pertaining to outcomes of concurrent CI and translabyrinthine tumor removal in detail and (2) perform an aggregate analysis of outcomes for case reports and series. Design Systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Setting Review of literature using PubMed and Cochrane databases. Participants Eligibility included patients undergoing translabyrinthine excision of vestibular schwannoma with concurrent CI. Main Outcome Measures Open-set speech discrimination scores, sound localization, patient-reported outcome measures. Results Forty-one subjects were identified. Two prospective studies have been performed, which showed improvement in speech localization and patient-reported outcome measures. While the majority of patients achieved open set speech recognition, data pertaining to improvement in speech perception were variable. Approximately 85% of subjects had audibility with their CI. Of those that achieved open-set speech discrimination, 75% could be classified as either intermediate or high performers. The majority of low performers in open-set speech either endorsed subjective benefit or demonstrated improvement compared to preoperative measures. There was a high risk of selection and reporting bias. Conclusions The majority of patients undergoing translabyrinthine excision of vestibular schwannoma with concurrent CI achieve open set speech perception, with 75% of these patients meeting criteria for being intermediate to high performers. Additional benefits include improved subjective hearing measures, decreased tinnitus, and improved sound localization.
Collapse
Affiliation(s)
- Nicholas J Thompson
- Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Brendan P O'Connell
- Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Kevin D Brown
- Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| |
Collapse
|
17
|
Bartindale MR, Tadokoro KS, Kircher ML. Cochlear Implantation in Sporadic Vestibular Schwannoma: A Systematic Literature Review. J Neurol Surg B Skull Base 2019; 80:632-639. [PMID: 31750050 DOI: 10.1055/s-0038-1676768] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022] Open
Abstract
Objective This study was aimed to perform a systematic literature review by examining outcomes in patients with sporadic vestibular schwannoma (VS) undergoing ipsilateral cochlear implant (CI). Data Sources PubMed-NCBI (National Center for Biotechnology Information) and Scopus databases were searched through October 2017. Study Selection Studies reporting auditory outcomes for each patient when a CI was placed with an ipsilateral sporadic VS were included. Main Outcome Measures Demographic variables, VS characteristics, preoperative hearing metrics, duration of deafness, CI type, approach to tumor resection, postoperative auditory outcomes, and postoperative tinnitus outcomes were reported for each eligible patient within studies. Each study was evaluated for quality and bias. Results Fifteen studies and 45 patients met inclusion criteria. Mean speech discrimination score (SDS) improved from 30.0 to 56.4% after CI placement. The majority when reported had an improvement in tinnitus. Preoperative ipsilateral SDS was a negative predictor of postoperative SDS, while neither tumor resection status, tumor location, duration of deafness, ipsilateral pure tone average, nor timing of CI placement had a significant effect on patient outcome. Conclusions Notwithstanding the challenges inherent with surveillance magnetic resonance imaging (MRI) in the setting of a cochlear implant magnet, select sporadic vestibular schwannoma patients can be considered for cochlear implantation.
Collapse
Affiliation(s)
- Matthew Robert Bartindale
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, United States
| | - Kent Sean Tadokoro
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, United States
| | - Matthew Lowell Kircher
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, United States
| |
Collapse
|
18
|
Deep NL, Dowling EM, Jethanamest D, Carlson ML. Cochlear Implantation: An Overview. J Neurol Surg B Skull Base 2018; 80:169-177. [PMID: 30931225 DOI: 10.1055/s-0038-1669411] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022] Open
Abstract
A cochlear implant (CI) is a surgically implanted device for the treatment of severe to profound sensorineural hearing loss in children and adults. It works by transducing acoustic energy into an electrical signal, which is used to stimulate surviving spiral ganglion cells of the auditory nerve. The past 2 decades have witnessed an exponential rise in the number of CI surgeries performed. Continual developments in programming strategies, device design, and minimally traumatic surgical technique have demonstrated the safety and efficacy of CI surgery. As a result, candidacy guidelines have expanded to include both pre and postlingually deaf children as young as 1 year of age, and those with greater degrees of residual hearing. A growing proportion of patients are undergoing CI for off-label or nontraditional indications including single-sided deafness, retrocochlear hearing loss, asymmetrical sensorineural hearing loss (SNHL) in adults and children with at least 1 ear that is better than performance cut-off for age, and children less than 12 months of age. Herein, we review CI design, clinical evaluation, indications, operative technique, and outcomes. We also discuss the expanding indications for CI surgery as it relates to lateral skull base pathology, comparing CI to auditory brainstem implants, and address the concerns with obtaining magnetic resonance imaging (MRI) in CI recipients.
Collapse
Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, United States
| | - Eric M Dowling
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel Jethanamest
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, United States
| | - Matthew L Carlson
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| |
Collapse
|