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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] [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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Di Micco R, Salcher R, Lesinski-Schiedat A, Lenarz T. Long-Term Hearing Outcome of Cochlear Implantation in Cases with Simultaneous Intracochlear Schwannoma Resection. Laryngoscope 2024; 134:1854-1860. [PMID: 37676060 DOI: 10.1002/lary.31025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/13/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES The aim was to analyze the long-term hearing results after simultaneous microsurgical extirpation via enlarged cochleostomy and cochlear implantation in intracochlear schwannoma as compared with non-tumor single-side deafness patients. METHODS Microsurgical extirpation via enlarged cochleostomy with simultaneous cochlear implantation was performed in 15 cases of intracochlear schwannoma between 2014 and 2021. Speech recognition tests in German language and impedance performances were collected over 36 months of observation and compared with an internal cohort of 52 age matched non-tumor single-side deafness patients. Retrospective cohort study in a tertiary referral center. RESULTS The surgery proved feasible and uneventful in all cases. In the case of intracochlear schwannoma, the hearing rehabilitation results were highly satisfactory and comparable to those of the non-tumor single-side deafness cohort. The speech recognition performance improved steadily in the first 12 months; afterward, it remained stable, providing indirect evidence against tumor recurrence during the follow-up. One patient required implant revision surgery related to device failure, but no recurrence was registered in the 36 months of observation. CONCLUSIONS Cochlear implantation is the strategy of choice for hearing rehabilitation in case of intracochlear schwannomas in the long term. In particular, the combination of tumor extirpation via cochleostomy with a cochlear implantation in the same surgical time offers a viable therapy for intracochlear schwannoma, granting a sufficient degree of radicality without compromising the cochlear integrity. This technique allows for revision surgery if required. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1854-1860, 2024.
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Affiliation(s)
- Riccardo Di Micco
- Department of Otorhinolaryngology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Rolf Salcher
- Department of Otorhinolaryngology, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Thomas Lenarz
- Department of Otorhinolaryngology, Medizinische Hochschule Hannover, Hannover, Germany
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Wu J, Sun H, Chen B, Yuan Y, Wang W, Ren D. Full Endoscopic Resection of Intralabyrinthine Schwannomas: A Case Series. EAR, NOSE & THROAT JOURNAL 2023:1455613231176170. [PMID: 37269110 DOI: 10.1177/01455613231176170] [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: 06/04/2023] Open
Abstract
Objective: To investigate the technique and efficacy of fully endoscope resection of intralabyrinthine schwannomas (ILS) by transcanal transpromontorial endoscopic approach (TTEA). Study Design: Retrospective case review. Setting: Hospital. Patients: All patients who were affected by ILS, without extension to the internal auditory canal and underwent surgery with TTEA in our hospital in 2020. Intervention(s): Therapeutic. Main Outcome Measure(s): Recovery status, postoperative complications and remaining symptoms after surgery. Results: Three patients were included, all of which underwent gross total resections. The follow-up period was from 10 months to 2 years. No intraoperative and postoperative major complications were observed. There was no facial paralysis or cerebrospinal fluid leakage postoperatively. The hospitalization time of TTEA was 5 days. Three patients' vertigo was relieved after 1 week without receiving vestibular therapy. Only 1 patient complained of transient episodes of vertigo when climbing or holding heavy objects. Conclusions: TTEA has the advantages of clear vision to identify the anatomical structure, enabling complete tumor resection, reduced operation time, and faster postoperative recovery.Level of Evidence: IV.
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Affiliation(s)
- Jingfang Wu
- Department of Otorhinolaryngology, ENT Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Shanghai Auditory Medical Center, Shanghai, China
| | - Haojie Sun
- Department of Otorhinolaryngology, ENT Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Shanghai Auditory Medical Center, Shanghai, China
| | - Binjun Chen
- Department of Otorhinolaryngology, ENT Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Shanghai Auditory Medical Center, Shanghai, China
| | - Yasheng Yuan
- Department of Otorhinolaryngology, ENT Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Shanghai Auditory Medical Center, Shanghai, China
| | - Wuqing Wang
- Department of Otorhinolaryngology, ENT Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Shanghai Auditory Medical Center, Shanghai, China
| | - Dongdong Ren
- Department of Otorhinolaryngology, ENT Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Shanghai Auditory Medical Center, Shanghai, China
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Mankekar G, Holmes S. Hearing Rehabilitation in Vestibular Schwannoma. Audiol Res 2023; 13:357-366. [PMID: 37218842 DOI: 10.3390/audiolres13030031] [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: 11/14/2022] [Revised: 04/13/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
The most common complaint among patients with vestibular schwannoma (VS) is hearing loss. This significantly affects the quality of life before, during, and after treatment for patients with VS. Untreated hearing loss in VS patients may even lead to depression and feelings of social isolation. A variety of devices are available for hearing rehabilitation for patients with vestibular schwannoma. These include contralateral routing of hearing signals (CROSs), bone-anchored hearing devices, auditory brainstem implants (ABI), and cochlear implants. In the United States, ABI is approved for patients 12 years of age and older with neurofibromatosis type 2. In the past few years, cochlear implantation has been offered simultaneously or sequentially with tumor resection or irradiation, or even to patients whose VS have been monitored with serial imaging. However, determining the functional integrity of the auditory nerve in patients with vestibular schwannoma is a challenge. This review article consists of (1) the pathophysiology of vestibular schwannoma (VS), (2) hearing loss in VS, (3) treatment of VS and associated hearing loss, (4) options for auditory rehabilitation in patients with VS with their individual benefits and limitations, and (5) challenges in hearing rehabilitation in this cohort of patients to determine auditory nerve functionality. (6) Future directions.
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Affiliation(s)
- Gauri Mankekar
- Department of Otolaryngology, Louisiana State Health University Sciences Center, Shreveport, LA 71103, USA
| | - Sean Holmes
- Department of Otolaryngology, Cox Health Medical Group, Springfield, MO 35807, USA
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Franchella S, Ariano M, Bevilacqua F, Concheri S, Zanoletti E. Cochlear Implantation in Intralabyrinthine Schwannoma: Case Series and Systematic Review of the Literature. Audiol Res 2023; 13:169-184. [PMID: 36960978 PMCID: PMC10037605 DOI: 10.3390/audiolres13020017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/18/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
Intralabyrinthine schwannomas (ILS) are rare benign tumours arising from the peripheral branches of the cochlear or vestibular nerves in the membranous labyrinth, intracochlear schwannomas being the most frequent ones. When hearing is no longer feasible on the affected side, surgical removal along with simultaneous cochlear implantation can be proposed to the patient. We hereby present a systematic review of the literature on the topic, as well as two original cases from our centre (Ospedale Università degli Studi di Padova). Cochlear implantation in intracochlear schwannomas is feasible, with overall satisfactory hearing outcomes in accordance with the evidence found in the literature.
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Affiliation(s)
- Sebastiano Franchella
- Department of Neurosciences, Section of Otorhinolaryngology-Head and Neck Surgery, University of Padova, 35122 Padova, Italy
| | - Marzia Ariano
- Department of Neurosciences, Section of Otorhinolaryngology-Head and Neck Surgery, University of Padova, 35122 Padova, Italy
| | - Francesca Bevilacqua
- Department of Neurosciences, Section of Otorhinolaryngology-Head and Neck Surgery, University of Padova, 35122 Padova, Italy
| | - Stefano Concheri
- Department of Neurosciences, Section of Otorhinolaryngology-Head and Neck Surgery, University of Padova, 35122 Padova, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Section of Otorhinolaryngology-Head and Neck Surgery, University of Padova, 35122 Padova, Italy
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Curatoli L, Pontillo V, Quaranta N. Intralabyrinthine schwannomas: a two-case series and literature review with a focus on hearing rehabilitation. Eur Arch Otorhinolaryngol 2023; 280:2073-2079. [PMID: 36648549 PMCID: PMC10066102 DOI: 10.1007/s00405-023-07823-2] [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: 10/26/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE Intralabyrinthine schwannomas (ILSs) are an uncommon finding. Diagnosis is challenging and no gold standard treatment exists yet. In this article, we present a two-cases series and review the latest available literature to assess the best diagnostic and therapeutic scheme. METHODS We reviewed the latest available literature assessing most frequent and relevant sets of symptoms, clinical features of the disease, diagnostic tests and imaging, possible treatments and after-surgery hearing rehabilitation techniques. We then compared literature data to our own series ones. RESULTS ILSs clinical presentation and development may overlap with other, more common otological conditions. Full audiometric battery test, electrophysiological study of VEMPS and MRI with contrast enhancement all appear to be critical to correctly diagnose these tumors. Several treatments exist: radiological follow-up, radiation therapy, full or partial surgical excision. Hearing rehabilitation is mostly accomplished through simultaneous cochlear implantation. CONCLUSIONS Our case-series data matches the available literature. ILSs are a rare type of vestibular schwannomas. Diagnosis in challenging and delayed in time as all the diagnostic tests, yet sensitive, are not specific for ILSs. The most suitable treatment seems to be surgical excision of these tumors followed by simultaneous cochlear implantation to restore hearing.
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Affiliation(s)
- Luigi Curatoli
- Translational Biomedicine and Neurosciences Department, University of Bari, Bari, Italy.
| | - Vito Pontillo
- Translational Biomedicine and Neurosciences Department, University of Bari, Bari, Italy
| | - Nicola Quaranta
- Translational Biomedicine and Neurosciences Department, University of Bari, Bari, Italy
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