Auditory Outcomes After Simultaneous Translabyrinthine Vestibular Schwannoma Resection and Cochlear Implantation: A Prospective Case Series

Background Cochlear implantation (CI) has emerged as a potential strategy for auditory rehabilitation in patients undergoing vestibular schwannoma (VS) surgery. However, outcomes remain variable, particularly in patients with neurofibromatosis type 2 (NF2).Objective To evaluate auditory and patient-reported outcomes following simultaneous CI during VS resection.Method This prospective consecutive case series included six adult patients undergoing simultaneous translabyrinthine VS resection and CI. Three patients had sporadic VS and three had NF2-associated bilateral tumors. Audiological outcomes were assessed preoperatively (T0) and one year after CI activation (T1), including pure-tone average (PTA) and speech perception. Patient-reported outcomes included three questionaries.Results Auditory perception was achieved in all patients. Postoperative PTA was similar between sporadic and NF2 patients (29.5 dB vs. 31.75 dB). However, speech perception outcomes differed substantially. Sporadic VS patients achieved high performance (monosyllabic 90%, disyllabic 96%, sentence recognition (SR) 100%), whereas NF2 patients showed lower scores (monosyllabic 40.35%, disyllabic 38%, SR 35%). Tinnitus improved in all patients, with complete remission in 66.7% of cases.Conclusions Simultaneous CI during VS surgery is a feasible rehabilitation strategy in selected patients. Speech perception differed between sporadic and NF2 cases despite similar hearing thresholds, highlighting the importance of cochlear nerve integrity, tumor burden and duration of deafness.