An Assessment of the Binaural Benefits of Concurrent Cochlear Implantation and Vestibular Schwannoma Resection

Objective: To examine the eventual binaural benefits of cochlear implant (CI) placement during microsurgical resection of a vestibular schwannoma (VS). Background: Despite being increasingly accepted as a valid modality of hearing rehabilitation in the VS population, the longterm binaural and quality-of-life benefits of CI insertion in these patients remains understudied. The goal of the present work is to prospectively evaluate a small series of patients to formally assess for the presence of such benefits. Methods: This is a prospective case series at a tertiary academic center of patients undergoing simultaneous microsurgical resection and cochlear implantation for asymmetric hearing loss secondary to a VS. Patients were evaluated postoperatively via standard and aided audiometric testing, sound localization tasks, the Tinnitus Handicap Inventory (THI), the Speech, Spatial, and Qualities of Hearing Scal (SSQ), and the Nijmegen Cochlear Implant Questionnaire (NCIQ) with a goal of better defining the audiometric, binaural, and quality-of-life benefits of implantation in this population. Results: Six patients underwent simultaneous VS resection and CI placement. Postoperatively, 1 patient did not obtain sound perception in their implanted ear and was excluded. Four patients (66.6% of the total cohort) obtained open-set speech at the last recorded evaluation. Comparing testing with the CI on versus CI off at the most recent evaluation, there was no significant difference observed in AzBio testing in noise (39 vs 44, P = 0.823), sound localization (40 vs 25, P = 0.334), or THI (0 vs 8, P = 0.569). Evaluating results over the available follow-up period, there was a significant improvement in SSQ scores comparing the first and last available postoperative evaluations (17.6 vs 19.6, P = 0.017). Although it did not reach statistical significance, there was also clinically significant improvement in NCIQ scores (175.3 vs 222.1, P = 0.069). There were no other significant improvements during this period. Conclusions: Although patients who undergo simultaneous VS resection and CI placement may obtain open-set speech, they may not achieve the same level of binaural hearing that is reported in other populations. Despite this, there remains potential for quality-of-life benefits if appropriate implant function is obtained.