Adaptation of the Standardized Hearing Outcomes Scattergram to Hearing Preservation in Cochlear Implantation

Objectives: To report a case of profound bilateral sensorineural hearing and vestibular loss from relapsing polychondritis and hearing outcomes after cochlear implantation. Methods: Case report and literature review. Results: A 43 year-old woman developed sudden loss of hearing and balance that progressed over several weeks to bilateral, profound hearing and vestibular loss. Steroid treatments were ineffective. She underwent vestibular physical therapy and left cochlear implantation. About 10 months after her initial presentation, she developed erythema, warmth, swelling, and pain of the left auricle sparing the lobule, flattening of the bridge of her nose, and right ankle swelling, warmth, and skin erythema. A biopsy of the left auricle revealed histopathologic findings consistent with relapsing polychondritis. She was treated with high dose prednisolone. The ear inflammation resolved, however, despite excellent auditory response to pure tone thresholds, the patient reported no improvement in speech perception after cochlear implantation. Conclusions: Relapsing polychondritis can present with rapidly progressive, profound loss of hearing and vestibular function. Hearing outcomes after cochlear implantation can include poor speech discrimination despite good pure tone detection thresholds.

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766 Endoscopic Surgery for Sporadic Vestibular Schwannoma Resection: A Systematic Review of Surgical Outcomes

British Journal of Surgery ◽

10.1093/bjs/znab134.324 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Chiuta ◽

S Raza-Knight ◽

A Alalade

Keyword(s):

Facial Nerve ◽

Hearing Preservation ◽

Extent Of Resection ◽

Current Data ◽

Resection Rate ◽

Eighth Cranial Nerve ◽

Nerve Preservation ◽

Microsurgical Resection ◽

Hearing Outcomes ◽

Series Report

Abstract Introduction Vestibular schwannomas (VS) are benign intracranial tumours originating from the vestibular division of the eighth cranial nerve. The mainstay of their surgical management is microsurgery, other options are radiotherapy or radiological monitoring. Endoscopy (ES) is becoming widely used in neurosurgery and may have a role in improving visualisation and outcomes by enhancing extent of resection, facial nerve, and hearing preservation in VS resection and describe the postoperative outcomes. Method The review was conducted according to the PRISMA guidelines and yielded 31 studies for inclusion. Systematic searches of literature databases were done for studies where endoscopic-assisted and/or endoscopic resection of VS were reported. Results ES facial nerve preservation rates (median 91.3%, range 39.0 - 100%) were comparable to microsurgical treatment. Hearing outcomes were more variable in ES series and were under-reported. A median gross total resection rate of 97.4% (61.0 - 100%) was achieved in the ES series. Conclusions Current data suggest that ES-assisted resection of sporadic VS is not inferior to microsurgical resection with respect to facial nerve outcomes and extent of resection. However, some ES series report poor hearing outcomes, which are under-reported in the literature.

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Cochlear Implantation in Children with Postlingual Progressive Steeply Sloping High-Frequency Hearing Loss

Journal of the American Academy of Audiology ◽

10.3766/jaaa.16115 ◽

2017 ◽

Vol 28 (10) ◽

pp. 913-919 ◽

Cited By ~ 7

Author(s):

Margaret A. Meredith ◽

Jay T. Rubinstein ◽

Kathleen C. Y. Sie ◽

Susan J. Norton

Keyword(s):

Hearing Loss ◽

Speech Perception ◽

Hearing Aids ◽

Cochlear Implantation ◽

High Frequency ◽

Case Series ◽

Hearing Preservation ◽

Rapid Improvement ◽

Retrospective Case ◽

Monosyllabic Word

Background: Children with steeply sloping sensorineural hearing loss (SNHL) lack access to critical high-frequency cues despite the use of advanced hearing aid technology. In addition, their auditory-only aided speech perception abilities often meet Food and Drug Administration criteria for cochlear implantation. Purpose: The objective of this study was to describe hearing preservation and speech perception outcomes in a group of young children with steeply sloping SNHL who received a cochlear implant (CI). Research Design: Retrospective case series. Study Sample: Eight children with steeply sloping postlingual progressive SNHL who received a unilateral traditional CI at Seattle Children’s Hospital between 2009 and 2013 and had follow-up data available up to 24 mo postimplant were included. Data Collection and Analysis: A retrospective chart review was completed. Medical records were reviewed for demographic information, preoperative and postoperative behavioral hearing thresholds, and speech perception scores. Paired t tests were used to analyze speech perception data. Hearing preservation results are reported. Results: Rapid improvement of speech perception scores was observed within the first month postimplant for all participants. Mean monosyllabic word scores were 76% and mean phoneme scores were 86.7% at 1-mo postactivation compared to mean preimplant scores of 19.5% and 31.0%, respectively. Hearing preservation was observed in five participants out to 24-mo postactivation. Two participants lost hearing in both the implanted and unimplanted ear, and received a sequential bilateral CI in the other ear after progression of the hearing loss. One participant had a total loss of hearing in only the implanted ear. Results reported in this article are from the ear implanted first. Bilateral outcomes are not reported. Conclusions: CIs provided benefit for children with steeply sloping bilateral hearing loss for whom hearing aids did not provide adequate auditory access. In our cohort, significant improvements in speech understanding occurred rapidly postactivation. Preservation of residual hearing in children with a traditional CI electrode is possible.

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Intraoperative Electrically Evoked Compound Action Potential (ECAP) Measurements in Traditional and Hearing Preservation Cochlear Implantation

Journal of the American Academy of Audiology ◽

10.3766/jaaa18052 ◽

2019 ◽

Author(s):

Ashley M. Nassiri ◽

Robert J. Yawn ◽

Ren´e H. Gifford ◽

David S. Haynes ◽

Jillian B. Roberts ◽

...

Keyword(s):

Action Potential ◽

Cochlear Implantation ◽

Compound Action Potential ◽

Hearing Preservation ◽

Evoked Compound Action Potential ◽

Compound Action

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Impact of the round window membrane accessibility on hearing preservation in adult cochlear implantation

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-017-4628-2 ◽

2017 ◽

Vol 274 (8) ◽

pp. 3049-3056 ◽

Cited By ~ 4

Author(s):

Marjan Mirsalehi ◽

Saleh Mohebbi ◽

Mahsa Ghajarzadeh ◽

Thomas Lenarz ◽

Omid Majdani

Keyword(s):

Cochlear Implantation ◽

Round Window ◽

Hearing Preservation ◽

Round Window Membrane

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Ipsilateral Cochlear Implantation in the Presence of Observed and Irradiated Vestibular Schwannomas

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420935482 ◽

2020 ◽

Vol 129 (12) ◽

pp. 1229-1238

Author(s):

Matthew J. Urban ◽

Dennis M. Moore ◽

Keri Kwarta ◽

John Leonetti ◽

Rebecca Rajasekhar ◽

...

Keyword(s):

Hearing Loss ◽

Cochlear Implantation ◽

Neurofibromatosis Type ◽

Auditory Brainstem ◽

Observation Time ◽

Vestibular Schwannomas ◽

Open Set ◽

Pubmed Database ◽

Auditory Brainstem Implants ◽

Hearing Outcomes

Objectives: Historically, eventual loss of cochlear nerve function has limited patients with neurofibromatosis type 2 (NF2) to auditory brainstem implants (ABI), which in general are less effective than modern cochlear implants (CI). Our objective is to evaluate hearing outcomes following ipsilateral cochlear implantation in patients with NF2 and irradiated vestibular schwannomas (VS), and sporadic VS that have been irradiated or observed. Methods: Multi-center retrospective analysis of ipsilateral cochlear implantation in the presence of observed and irradiated VS. MESH search in NCBI PubMed database between 1992 and 2019 for reported cases of cochlear implantation with unresected vestibular schwannoma. Results: Seven patients underwent ipsilateral cochlear implantation in the presence of observed or irradiated vestibular schwannomas. Four patients had sporadic tumors with severe-profound contralateral hearing loss caused by presbycusis/hereditary sensorineural hearing loss, and three patients with NF2 lost contralateral hearing after prior surgical resection. Prior to implantation, one VS was observed without growth for a period of 7 years and the others were treated with radiotherapy. Mean post-operative sentence score was 63.9% (range 48-91) at an average of 28 (range 2-84) months follow up. All patients in this cohort obtained open set speech perception. While analysis of the literature is limited by heterogenous data reporting, 85% of implants with observed schwannomas achieved some open set perception, and 67% of patients previously radiated schwannomas. Furthermore, blending literature outcomes for post implantation sentence testing in quiet without lip-reading show 59.0 ± 35% for patients with CI and observed tumors and 55.7 ± 35% for patients with radiated tumors, with both groups ranging 0 to 100%. Conclusion: This retrospective series and literature review highlight that hearing outcomes with CI for VS patients are superior to those achieved with ABI. However, important considerations including imaging, delayed hearing loss, and observation time cannot be ignored in this population.

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Optimal outcomes for hearing preservation in the management of small vestibular schwannomas

The Journal of Laryngology & Otology ◽

10.1017/s0022215116007969 ◽

2016 ◽

Vol 130 (7) ◽

pp. 606-610 ◽

Cited By ~ 9

Author(s):

K A Peng ◽

E P Wilkinson

Keyword(s):

Hearing Preservation ◽

Vestibular Schwannomas ◽

Middle Fossa ◽

Stereotactic Radiation ◽

Middle Fossa Approach ◽

Small Tumour ◽

Optimal Outcomes ◽

Definitive Therapy ◽

Hearing Outcomes

AbstractObjective:To undertake a systematic review of the role of microsurgery, in relation to observation and stereotactic radiation, in the management of small vestibular schwannomas with serviceable hearing.Methods:The Medline database was searched for publications that included the terms ‘vestibular schwannoma’ and/or ‘acoustic neuroma’, occurring in conjunction with ‘hearing’. Articles were manually screened to identify those concerning vestibular schwannomas under 1.5 cm in greatest dimension. Thereafter, only publications discussing both pre-operative and post-operative hearing were considered.Results:Twenty-six papers were identified. Observation is an acceptable strategy for small tumours with slow growth where hearing preservation is not a consideration. In contrast, microsurgery, including the middle fossa approach, may provide excellent hearing outcomes, particularly when a small tumour has begun to cause hearing loss. Immediate post-operative hearing usually predicts long-term hearing. Recent data on stereotactic radiation suggest long-term deterioration of hearing following definitive therapy.Conclusion:In patients under the age of 65 years with small vestibular schwannomas, microsurgery via the middle fossa approach offers durable preservation of hearing.

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