Cochlear implantation in a patient after removal of an acoustic neuroma. The implications of magnetic resonance imaging with gadolinium on patient management.

The advent of magnetic resonance imaging has allowed otologists to focus on the early removal of acoustic neuromas with the goal of hearing preservation. Clearly, there are some unpredictable factors, such as placement of the tumor in the medial vs the lateral segment of the internal auditory canal and the capricious nature of the blood supply to these benign neoplasms, that make prediction of hearing preservation difficult. Nonetheless, the present goal of surgery for removal of acoustic tumors has changed its focus from preservation of the facial nerve alone to preservation of the facial nerve and preservation of hearing. In a patient with an only-hearing ear and a small acoustic neuroma, there is some controversy concerning whether the tumor should be removed early, with the goal of hearing preservation, or if the patient should be allowed to progress to a considerable hearing loss in an effort to preserve natural hearing as long as possible. We report a case in which an acoustic tumor was removed from an only-hearing ear in a patient with neurofibromatosis after hearing loss had progressed in that ear but before the development of total deafness. Postoperatively, the patient successfully underwent cochlear implantation. We also discuss decisions that we made during the surgical procedure, as well as the feasibility of cochlear implantation in patients with profound deafness after the excision of acoustic neuromas.