Urban Matthew J, Moore Dennis M, Kwarta Keri, Leonetti John, Rajasekhar Rebecca, Gluth Michael B, Wiet R Mark
Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, USA.
Ann Otol Rhinol Laryngol. 2020 Dec;129(12):1229-1238. doi: 10.1177/0003489420935482. Epub 2020 Jun 18.
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.
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.
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%.
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.
从历史上看，耳蜗神经功能最终丧失使2型神经纤维瘤病（NF2）患者只能选择听觉脑干植入物（ABI），而一般来说，ABI的效果不如现代人工耳蜗（CI）。我们的目的是评估NF2患者以及接受过放疗的前庭神经鞘瘤（VS）和接受过放疗或观察的散发性VS患者同侧人工耳蜗植入后的听力结果。
对观察到的和接受过放疗的VS患者同侧人工耳蜗植入进行多中心回顾性分析。1992年至2019年期间在NCBI PubMed数据库中进行医学主题词（MESH）检索，以查找未切除前庭神经鞘瘤的人工耳蜗植入报告病例。
7例患者在观察到或接受过放疗的前庭神经鞘瘤情况下接受了同侧人工耳蜗植入。4例患者患有散发性肿瘤，因老年性耳聋/遗传性感音神经性听力损失导致对侧重度至极重度听力损失，3例NF2患者在先前手术切除后丧失了对侧听力。植入前，1例VS观察到7年无生长，其他患者接受了放射治疗。平均术后语句得分在平均28个月（范围2 - 84个月）的随访中为63.9%（范围48 - 91）。该队列中的所有患者都获得了开放集言语感知。虽然文献分析受到异质性数据报告的限制，但85%观察到神经鞘瘤的植入物实现了一定程度的开放集感知，先前接受过放疗的神经鞘瘤患者中这一比例为67%。此外，对植入后安静环境下无唇读语句测试的文献结果进行综合分析显示，患有CI且观察到肿瘤的患者为59.0±35%，接受过放疗的肿瘤患者为55.7±35%，两组范围均为0至100%。
这个回顾性系列研究和文献综述强调，VS患者使用CI的听力结果优于使用ABI的结果。然而，在这一人群中，包括影像学、迟发性听力损失和观察时间等重要因素不容忽视。
