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Management of sporadic vestibular schwannoma with contralateral nonserviceable hearing
Author(s) -
Jia Huan,
Nguyen Yann,
De Seta Daniele,
Hochet Baptiste,
Smail Mustapha,
Bernardeschi Daniele,
Wu Hao,
Mosnier Isabelle,
Kalamarides Michel,
Sterkers Olivier
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28369
Subject(s) - medicine , schwannoma , vestibular system , etiology , acoustic neuroma , audiology , hearing loss , otorhinolaryngology , auditory brainstem response , surgery
Objectives/Hypothesis To outline a possible decision‐making process for sporadic vestibular schwannoma (VS) with contralateral nonserviceable hearing at diagnosis. Study Design Retrospective case series. Methods Diagnosed VS was studied in a tertiary referral center from 1995 to 2013. Results Twenty‐eight patients were included, with a mean follow‐up of 6.9 years (range = 0.5–20 years). Ten were stage 1, 10 were stage 2, five were stage 3, and three were stage 4. Ipsilateral hearing levels were A (n = 3), B (n = 10), C (n = 7) and D (n = 8) American Academy of Otolaryngology–Head and Neck Surgery classification. Contralateral hearing levels were C (n = 11) and D (n = 17). Initial VS management included surveillance (n = 12) or surgery (n = 16), and four patients were later treated with surgery (n = 3) or stereotactic irradiation (n = 1). Hearing was improved by hearing aids and/or etiological treatment (n = 8), restored by contralateral (n = 15) or ipsilateral (n = 4) cochlear implants (CIs), or ipsilateral auditory brainstem implants (ABIs) (n = 3). Finally, 18 CIs were active daily; 14 of them presented high or moderate benefit with mean open‐set dissyllabic word scores (WRS) of 58.1% and sentence recognition scores (SRS) of 69.7%, but only one ABI was still active (WRS of 70% and SRS of 87% with lip reading). Conclusions When early removal of VS was not necessary, contralateral CI or etiological treatment for hearing loss might be recommended initially. Ipsilateral CI is proposed, whereas VS should be operated on if previous hearing restoration was not successful. ABI should be reserved for the rare cases where a contralateral CI could not be implanted or the cochlear nerve was sectioned during VS removal. Level of Evidence 3 Laryngoscope, 130:E407–E415, 2020