Simultaneous Translabyrinthine Vestibular Schwannoma Removal and Cochlear Implantation: Assessment of Wireless Connection Speech Test

Abstract

Objective

Simultaneous vestibular schwannoma (VS) removal via the translabyrinthine approach (TLA) and cochlear implantation (CI) allows for overlapping surgical fields, improving postoperative hearing outcomes, and minimizing complications associated with multiple surgical interventions. However, the effectiveness of this surgical approach remains a topic of debate. To address this, we aim to evaluate surgical outcomes using an objective wireless connection speech test to ensure accurate auditory performance.

Methods

We describe six patients with simultaneous TLA and CI surgery from 2020 to 2024. All patients presented with single-sided deafness or asymmetric hearing loss due to vestibular schwannomas classified as Koos grade I or II, confined to the internal auditory canal. Preoperative and postoperative hearing outcomes were assessed through pure-tone audiometry thresholds, word recognition scores, Visual Analog Scale (VAS), and Abbreviated Profile of Hearing Aid Benefit survey (APHAB). Magnetic resonance imaging (MRI) confirmed that tumors were either completely or nearly completely excised. Postoperative hearing outcomes were also evaluated through Sound Field (unplugging) tests, occlusion plugging tests, and the iPad speech test—a wireless transmission of recorded sound directly to the CI's speech processor.

Results

The pure-tone audiometry thresholds and word recognition scores improved from preoperative to postoperative assessments (p = 0.0002 and p = 0.03, respectively). Of the five patients who performed the postoperative iPad speech test, monosyllabic and disyllabic scores were consistently lower than the outcomes from the plugged and unplugged tests. Notably, two patients reported no measurable iPad-based speech recognition despite measurable performance on the plugged test. Additionally, APHAB scores showed significant improvement across all patients.

Conclusion

Simultaneous TLA and CI emerges as an effective procedure for restoring hearing in patients with small vestibular schwannomas, allowing the recovery of binaural hearing.

Level of Evidence

4