Comparing Cochlear Implant Outcomes in 100 Patients with Sporadic Vestibular Schwannoma Managed with Observation, Radiosurgery, or Microsurgery: A Multi-Institutional Review

Objective: To compare cochlear implant (CI) speech perception outcomes in patients with sporadic vestibular schwannoma (VS) managed with observation, radiosurgery, or microsurgery.

Study Design:: Retrospective review.

Setting:: Eleven tertiary academic medical centers.

Patients:: One hundred patients with sporadic VS who received an ipsilateral CI.

Interventions:: Ipsilateral cochlear implantation.

Main Outcome Measures:: Pure tone thresholds, consonant–nucleus–consonant (CNC) speech perception testing scores, and rates of open-set speech acquisition.

Results: Of the 100 patients studied, 54 underwent microsurgery, 26 radiosurgery, 19 continued observation, and 1 underwent multimodal therapy. Among all patients, the median postimplantation pure tone average was 31 dB (IQR: 25–39) and the median CNC word score was 32% (IQR: 5–66) at a median of 12 months (IQR: 5–25) postimplantation. Patients who were managed with microsurgery (median CNC: 16%, IQR: 0–55) exhibited poorer implant outcomes overall compared to those managed with observation (median CNC: 52%, IQR: 40–72) or radiosurgery (median CNC: 32%, IQR: 26–67). Open-set speech perception was achieved in 56% of patients managed with microsurgery, 94% with observation, and 80% with radiosurgery. In a multivariable setting, those managed with observation (p = 0.01) or who underwent radiosurgery (p = 0.03) were significantly more likely to achieve open-set speech perception compared to patients who underwent microsurgery.

Conclusions: Cochlear implants offer benefit in selected patients with sporadic VS. Although achieved in over half of people after microsurgery, open-set speech perception is more reliably attained in patients who are treated with observation or radiosurgery compared to microsurgical resection. These data may inform patient counseling and VS tumor management in people who may benefit from implantation.

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Artikel online veröffentlicht:
05. Februar 2024