Huan Jia1,2, Yann Nguyen1,3, Daniele De Seta1,3, Baptiste Hochet1,3, Mustapha Smail1,3, Daniele Bernardeschi1,3, Hao Wu2, Isabelle Mosnier1,3, Michel Kalamarides4, Olivier Sterkers1,3,2. 1. Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France. 2. Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. 3. Inserm "Minimally Invasive Robot-Based Hearing Rehabilitation", Sorbonne University, Paris, France. 4. Neurosurgery Department, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France.
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.
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.