Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
Otol Neurotol. 2023 Sep 1;44(8):791-797. doi: 10.1097/MAO.0000000000003963. Epub 2023 Jul 18.
Compare cochlear implant (CI) performance between patients with ipsilateral sporadic vestibular schwannoma (VS) and NF2-related schwannomatosis (NF2). Compare CI performance according to VS management modality.
Historical cohort.
Tertiary academic center.
Forty-nine patients (52 ears) undergoing cochlear implantation in the setting of ipsilateral sporadic (n = 21) or NF2-associated VS (n = 28).
CI ipsilateral to VS.
Auditory thresholds, consonant-nucleus-consonant (CNC) word scores, and AzBio sentences in quiet scores.
Among all patients, median post-CI pure tone average was 28 dB HL (interquartile range [IQR], 21-38), CNC word score was 39% (IQR, 6-62), and AzBio sentences in quiet score was 60% (IQR, 11-83) at a median of 12.5 months postimplantation. Despite the NF2 cohort having larger tumors, when comparing patients with sporadic versus NF2-associated VS, there were no statistically significant differences in CNC word (49% [30-70] vs. 31% [0-52]) or AzBio sentences in quiet (66% [28-80] vs. 57% [5-83]) scores. Regardless of NF2 status, all patients managed with observation, and radiosurgery achieved open-set speech. In patients who underwent microsurgery, 6 (46%) of 13 with NF2 achieved open-set speech recognition compared with 4 (67%) of 6 with sporadic disease.
Select patients with VS achieve successful hearing rehabilitation with a CI. In this cohort, tumor management strategy significantly influenced CI performance, whereas differences in NF2 status exhibited less effect. Specifically, all patients managed with observation or radiosurgery achieved open-set speech perception, whereas approximately half of people with NF2-related VS and two-thirds of people with sporadic VS achieved this outcome after tumor microsurgery. When disease permits, observation and radiosurgery should be considered in patients who may later pursue a CI.
比较同侧散发性前庭神经鞘瘤（VS）和 NF2 相关神经鞘瘤病（NF2）患者的人工耳蜗植入（CI）效果。根据 VS 管理方式比较 CI 效果。
历史队列研究。
三级学术中心。
49 例（52 耳）在同侧散发性（n = 21）或 NF2 相关 VS（n = 28）的情况下接受人工耳蜗植入。
VS 同侧的 CI。
听觉阈值、辅音-核-辅音（CNC）词得分和安静时 AzBio 句子得分。
在所有患者中，CI 后中位纯音平均听阈为 28 dB HL（四分位距[IQR]，21-38），CNC 词得分 39%（IQR，6-62），安静时 AzBio 句子得分 60%（IQR，11-83），中位数为植入后 12.5 个月。尽管 NF2 组肿瘤较大，但比较散发性 VS 与 NF2 相关 VS 患者时，CNC 词（49%[30-70]与 31%[0-52]）或 AzBio 句子在安静时（66%[28-80]与 57%[5-83]）得分无统计学差异。无论 NF2 状态如何，所有接受观察和放射外科治疗的患者均获得开放式言语识别。在接受显微镜手术的患者中，13 例 NF2 患者中有 6 例（46%）获得开放式言语识别，而 6 例散发性疾病患者中有 4 例（67%）。
选择合适的 VS 患者可通过 CI 获得成功的听力康复。在本队列中，肿瘤管理策略显著影响 CI 效果，而 NF2 状态的差异影响较小。具体来说，所有接受观察或放射外科治疗的患者均获得开放式言语感知，而大约一半的 NF2 相关 VS 患者和三分之二的散发性 VS 患者在肿瘤显微镜手术后获得该结果。在疾病允许的情况下，对于可能以后需要接受 CI 的患者，应考虑观察和放射外科治疗。
