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Hershey E, Chionis L, Kazemi R, Valenzuela C, El-Kashlan HK, Basura GJ, Stucken EZ. Changing Management of Intravestibular Schwannomas in the Era of Cochlear Implantation for Single-Sided Deafness. Otol Neurotol 2024; 45:e337-e341. [PMID: 38361345 DOI: 10.1097/mao.0000000000004140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Intralabyrinthine schwannomas (ILSs) are a rare cause of deafness. Patients with ILS confined to the semicircular canals and the vestibule (intravestibular schwannomas) are potential candidates for cochlear implantation for hearing rehabilitation, a new option for patients with unilateral hearing loss since the 2019 FDA approval of cochlear implant (CI) for single-sided deafness. In this report, we describe an evolving management approach for ILSs causing hearing loss. PATIENTS Adults (≥18 years) who underwent simultaneous ILS resection and CI between January 2019 and June 2023 (n = 3). INTERVENTION Transmastoid labyrinthectomy with simultaneous cochlear implantation. MAIN OUTCOME MEASURES Hearing performance with cochlear implantation measured as CNC Word Recognition scores and AzBio Sentence scores. RESULTS Three patients with ILS confined to the semicircular canals and vestibule underwent simultaneous tumor resection via labyrinthectomy with CI placement. In all cases, complete tumor resection and full CI insertion were achieved. No patients experienced postoperative complications. Patients 1 and 2 underwent 6- and 9-month postactivation testing, respectively, with CNC scores 64% to 80% and AzBio 81% to 99% in the implanted ears. Patient 3 scored 0% on CNC and AzBio testing at 3 months and deferred her 6-month audiometry. CONCLUSIONS Patients with ILS confined to the vestibule and semicircular canals can be considered for simultaneous tumor resection and CI placement.
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Affiliation(s)
- Emma Hershey
- University of Michigan Medical School, Ann Arbor, MI
| | - Lisa Chionis
- University of Michigan Medical School, Ann Arbor, MI
| | - Ruby Kazemi
- University of Michigan Medical School, Ann Arbor, MI
| | - Carla Valenzuela
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Hussam K El-Kashlan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Gregory J Basura
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Emily Z Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
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Carasek N, Cristovão D, Oliveira LAT, Caldas FF, Correia FM, Elias TGA, Amorim R, Bahmad Jr F. Middle Ear Cholesteatoma and Vestibular Schwannoma Resection Followed by Cochlear Implant: Surgical Challenges and Audiological Outcomes. J Clin Med 2023; 12:7139. [PMID: 38002751 PMCID: PMC10672219 DOI: 10.3390/jcm12227139] [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: 08/09/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: The occurrence of vestibular schwannoma (VS) associated with cholesteatoma is rare. A hearing impairment is one of the most significant issues in such cases. Moreover, the presence of middle and inner ear pathologies combined may represent a surgical challenge. No studies have described a combined surgical approach for these coexisting conditions (VS and cholesteatoma), nor the hearing rehabilitation outcomes of using cochlear implants for these patients. (2) Case Report: This paper is on a female patient who underwent simultaneous surgical treatments for VS and middle ear cholesteatoma in the right ear followed by a cochlear implant, describing the technique and the audiological results. (3) Conclusions: The surgical approach was successful and enabled the resection of lesions with the auditory nerve and cochlea preservation. Cochlear implantation in the right ear showed positive postoperative results, with an improvement in the results with the CI in silent and noisy environments.
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Affiliation(s)
- Natalia Carasek
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
| | - Danielle Cristovão
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
| | - Lucas Alves Teixeira Oliveira
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
| | | | - Fernando Massa Correia
- Brazilian Institute of Otorhinolaryngology, Federal District, Brasília 70710-149, Brazil
| | | | - Rivadávio Amorim
- Faculty of Medical Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil
| | - Fayez Bahmad Jr
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
- Brazilian Institute of Otorhinolaryngology, Federal District, Brasília 70710-149, Brazil
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Schwam ZG, Cosetti MK, Wanna GB. Translabyrinthine Approach for Sporadic Vestibular Schwannoma: Patient Selection, Technical Pearls, and Patient Outcomes. Otolaryngol Clin North Am 2023; 56:483-493. [PMID: 36964096 DOI: 10.1016/j.otc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Herein we briefly describe the translabyrinthine approach to vestibular schwannoma resection as well as a focused literature review as to the best candidates, technical recommendations, and key outcomes with respect to other approaches.
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Affiliation(s)
- Zachary G Schwam
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA.
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
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Schaumann K, Albrecht A, Turowski B, Hoffmann C, Cornelius JF, Schipper J. [Cochlear nerve continuity preservation during retrosigmoid ablative osteotomy of the internal auditory canal for advanced vestibular schwannomas]. HNO 2022; 70:445-454. [PMID: 34812915 PMCID: PMC9160153 DOI: 10.1007/s00106-021-01116-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
The data of 86 patients with retrosigmoid microsurgical resection of vestibular schwannoma in tumor stage Koos II-IV were evaluated. In more than two thirds of the cases it was shown that the cochlear nerve followed the facial nerve, which is easily identified by electroneurography, in recurrent similar patterns in the region of the internal auditory canal. Starting from the fundus, this facilitated early identification and thus preservation of continuity of the cochlear nerve in the course of the internal auditory canal. This was of particular importance when safe functional preservation could not be guaranteed due to tumor size or formation despite intraoperative derivation of somatosenoric potentials, but when the possibility of subsequent hearing rehabilitation with a cochlear implant should be granted. Preoperative MRI sequences gave an indication of the possible nerve courses in some cases, but intraoperative imaging in the internal auditory canal was superior to MRI.
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Affiliation(s)
- Katharina Schaumann
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Deutschland.
| | - A Albrecht
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Deutschland
| | - B Turowski
- Institut für diagnostische und interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - C Hoffmann
- Universitätsklinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - J F Cornelius
- Universitätsklinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - J Schipper
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Deutschland
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Sanna M, Piccirillo E, Kihlgren C, Cagliero G, Guidi M, Saleh E. Simultaneous Cochlear Implantation After Translabyrinthine Vestibular Schwannoma Resection: A Report of 41 Cases. Otol Neurotol 2021; 42:1414-1421. [PMID: 34369443 DOI: 10.1097/mao.0000000000003258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the auditory outcome of simultaneous translabyrinthine vestibular schwannoma (VS) resection and cochlear implantation (CI) after successful cochlear nerve preservation. STUDY DESIGN A retrospective case series and patient questionnaire. SETTING Quaternary referral center for skull base pathologies. PATIENTS Patients with small (<2 cm) sporadic or neurofibromatosis 2 related tumors were included in this study. INTERVENTION Vestibular schwannoma resection + simultaneous cochlear implantation. MAIN OUTCOME MEASURE Audiological performance postimplantation and perceived patients' benefits. RESULTS Forty-one patients were included. Thirty-three were sporadic VS and eight were neurofibromatosis 2. Auditory perception postimplantation was achieved in 33 patients (80.5%). At the last follow-up, 20 patients (48.8%) were users and 21 (51.2%) were nonusers. In the users' group, and after 1 year of implant activation, vowel identification was 75.3%, disyllabic word recognition 54%, sentence recognition 60.7%, and common phrase comprehension 61%, whereas in the nonusers' group and after 1 year of implant activation, vowel identification was 22.9%, disyllabic word recognition 14.8%, sentence recognition 15.3%, and common phrase comprehension 14%. Sixteen users were classified into 10 high performers, three intermediate performers, and three poor performers. In the user' group, the mean postimplantation pure tone average was 63.4 dB and the mean speech discrimination score was 63.7%. CONCLUSIONS Simultaneous CI and VS resection is a viable option with many patients achieving auditory perception and nearly half the patients are CI users at long follow-up.
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Affiliation(s)
| | | | | | | | | | - Essam Saleh
- Otolaryngology, Alex. University, Egypt
- Otology KAMC, Makka, Saudi Arabia
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Plontke SK, Caye-Thomasen P, Strauss C, Kösling S, Götze G, Siebolts U, Vordermark D, Wagner L, Fröhlich L, Rahne T. Management of transmodiolar and transmacular cochleovestibular schwannomas with and without cochlear implantation. HNO 2021; 69:7-19. [PMID: 33044580 PMCID: PMC7862215 DOI: 10.1007/s00106-020-00919-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Hearing 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). Methods This 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. Results Hearing 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. Conclusions Cochleovestibular 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 online The 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”. ![]()
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Affiliation(s)
- S K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - P Caye-Thomasen
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C Strauss
- Department of Neurosurgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - S Kösling
- Department of Radiation Medicine, Clinic for Radiology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - G Götze
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - U Siebolts
- Institute of Pathology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - D Vordermark
- Department of Radiation Medicine, Clinic for Radiotherapy, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
| | - L Wagner
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - L Fröhlich
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - T Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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[Management of transmodiolar and transmacular cochleovestibular schwannomas with and without cochlear implantation. German version]. HNO 2020; 68:734-748. [PMID: 32886128 DOI: 10.1007/s00106-020-00918-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Hearing 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). METHODS This 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. RESULTS Hearing 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. CONCLUSIONS Cochleovestibular 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.
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[Hearing classification in patients with vestibular schwannoma using German-language test procedures]. HNO 2020; 69:750-758. [PMID: 32975608 PMCID: PMC8413153 DOI: 10.1007/s00106-020-00948-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hearing function in patients with vestibular schwannoma is often classified according to the Gardner and Robertson (1988) or the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS, 1995) systems. These classification systems are based on English-language test procedures, there is no German-language equivalent. The aim of the study was to investigate the influence of various target parameters on hearing classification and to derive a recommendation for the use of German-language test methods. MATERIALS AND METHODS The rules for speech audiometry based on English-language test procedures were applied to German speech test materials. In 91 patients with vestibular schwannoma, pure tone hearing thresholds, speech recognition thresholds, and speech discrimination at different sound pressure levels were measured. The patients were categorized according to the Gardner and Robertson and AAO-HNS classifications. RESULTS In both the Gardner-Robertson and the AAO-HNS classifications, the number of patients in the hearing classes with serviceable hearing function (measured as Pure Tone Average across three (3PTA) or four (4PTA) frequencies) was highest when using the 3PTA0,5;1;2 kHz condition, followed by 4PTA0,5;1;2;3 kHz, 4PTA0,5;1;2;4 kHz, and 4PTA0,5;1;2;"3"kHz. If maximum word recognition score (WRSmax) was used instead of word recognition 40 dB above the sensation level (WRS40SL), more patients were classified into the hearing classes with serviceable hearing function, irrespective of the mean pure tone hearing threshold. CONCLUSION The Gardner-Robertson and AAO-HNS classifications can be used in German-speaking settings. The Freiburg monosyllabic test can be used to determine speech discrimination scores or maximum word recognition.
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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]
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Sudhoff H, Gehl HB, Scholtz LU, Todt I. MRI Observation After Intralabyrinthine and Vestibular Schwannoma Resection and Cochlear Implantation. Front Neurol 2020; 11:759. [PMID: 32903399 PMCID: PMC7434924 DOI: 10.3389/fneur.2020.00759] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/19/2020] [Indexed: 01/09/2023] Open
Abstract
Objective: MRI observation is part of the regular follow-up after vestibular schwannoma (VS) or intralabyrinthine schwannoma (ILS) resection. Because cochlear implantation (CI) after resection is part of the audiological rehabilitation process, the magnet resonance imaging (MRI) behavior of CI systems needs to be considered. In light of recent developments in MRI artifact positioning and pain prevention, this study evaluates reproducible MRI observations after tumor resection and CI surgery as part of follow-up. Methods: In a retrospective study, we evaluated 9 patients with a T1 KM, T2 sequence MRI observation, and cone beam computed tomography (CBCT) after ILS/VS resection and CI. In all but one case, a CI with a diametrically bipolar magnet and a receiver positioned 8-9 cm behind the external auditory canal was performed. Results: In all but one case, MRI observation allowed for a pain-free visual assessment of the intralabyrinthine and internal auditory canal (IAC) regions. In one case, a painful dislodgement of the receiver magnet occurred. Conclusion: MRI follow-up after ILS and VS resection and CI is reproducibly possible. Implant choice and positioning should be considered before implantation to allow for a pain-free visual assessment afterward. This finding allows for the first time a widening of the indication into this patient group.
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Affiliation(s)
- Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld University, Bielefeld, Germany
| | - Hans B. Gehl
- Department of Radiology, Klinikum Bielefeld, Bielefeld, Germany
| | - Lars U. Scholtz
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld University, Bielefeld, Germany
| | - Ingo Todt
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld University, Bielefeld, Germany
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