Tian Luchen, West Niels, Cayé-Thomasen Per
Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University Hospital of Copenhagen, Copenhagen, Denmark.
J Int Adv Otol. 2021 Sep;17(5):452-460. doi: 10.5152/iao.2021.21008.
Vestibular schwannomas (VS) frequently lead to ipsilateral sensorineural hearing loss (HL) as part of its natural history or as a result of treatment. Cochlear implantation represents a well-documented treatment of profound HL that cannot be treated adequately with a conventional hearing aid, thus being offered to selected VS patients. A functional cochlea and cochlear nerve are prerequisites for sound perception with a cochlear implant (CI). The potential impact of radiotherapy on these structures is thus an important issue for subsequent CI hearing outcomes. The objective of this article is to present a case and to review the existing literature on the outcomes of cochlear implantation in irradiated VS patients systematically.
A systematic literature review using preferred reporting items for systematic reviews and meta-analyses was conducted. Medline was searched systematically. Papers reporting ipsilateral CI outcomes after radiotherapy of VS were included. Additionally, results of CI after stereotactic radiotherapy in a 54-year-old male with neurofibromatosis type 2 are presented.
A total of 14 papers (33 patients) fulfilled inclusion criteria. Moderate preoperative HL was found in 11 patients. Six had moderate to severe HL, whereas 16 had severe HL or total deafness. Postoperative hearing outcomes varied from poor in 27% of patients to excellent in 19%, with remaining cases lying in between (mean follow-up of 19 months). Most patients achieved improvement in hearing and quality of life.
Despite variation in the degree of hearing outcome, CI after radiotherapy of VS appears to be effective in the majority of cases, as more than 70% of patients have good or excellent outcomes within 1-2 years post-implantation. Subjective benefits are considerable, even in cases with relatively poor objective outcome.
前庭神经鞘瘤（VS）在其自然病程中或治疗后常导致同侧感音神经性听力损失（HL）。对于常规助听器无法充分治疗的重度HL，人工耳蜗植入是一种有充分文献记载的治疗方法，因此会为部分VS患者提供该治疗。功能性耳蜗和蜗神经是使用人工耳蜗（CI）进行声音感知的前提条件。因此，放疗对这些结构的潜在影响是影响后续CI听力结果的一个重要问题。本文的目的是介绍一个病例，并系统回顾关于接受放疗的VS患者人工耳蜗植入结果的现有文献。
采用系统评价和Meta分析的首选报告项目进行系统文献回顾。系统检索了Medline。纳入报告VS放疗后同侧CI结果的论文。此外，还介绍了一名54岁2型神经纤维瘤男性患者接受立体定向放疗后的CI结果。
共有14篇论文（33例患者）符合纳入标准。11例患者术前为中度HL。6例为中度至重度HL，16例为重度HL或全聋。术后听力结果从27%的患者较差到19%的患者优秀不等，其余病例介于两者之间（平均随访19个月）。大多数患者的听力和生活质量得到改善。
尽管听力结果程度存在差异，但VS放疗后CI在大多数情况下似乎是有效的，因为超过70%的患者在植入后1 - 2年内有良好或优秀的结果。即使客观结果相对较差，主观获益也相当可观。
