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Hearing and Balance in Acoustic Neuroma

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A special issue of Audiology Research (ISSN 2039-4349).

Deadline for manuscript submissions: closed (15 July 2023) | Viewed by 19997

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Special Issue Editors

Dr. Elisabetta Zanoletti

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Guest Editor

Skull Base Unit, Otolaryngology Section, Department of Neuroscience, University of Padova, 35128 Padova, Italy
Interests: vestibular schwannoma; skull-base surgery; otology; neurotology; salivary gland tumors; temporal bone carcinomas
Special Issues, Collections and Topics in MDPI journals

Dr. Niccolo Favaretto

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Guest Editor

Dipartimento di Neuroscienze - DNS, Università degli Studi di Padova, 35100 Padua, Italy
Interests: vestibular schwannomas; hearing loss; hearing disorders; cochlear implant

Special Issue Information

Dear Colleagues,

Over the past 50 years, enormous progress has been made in the management of vestibular schwannomas (VSs), moving from a riskful surgery with high rates of perioperative morbidity to the current treatment strategies, where observation, radiotherapy and low-morbidity surgery are the current state of art. Preservation of the function of the facial nerve has become the mainstay of treatment, and every effort is spent to preserve it while removing the tumor. Together with the improvements achieved in both surgical and non-surgical treatment, a growing interest in hearing and balance function preservation and/or restoration has developed. Both hearing and balance functions can be negatively affected by the vestibular schwannoma, itself but also as a result of treatment. Different options for hearing preservation and rehabilitation have become available, but a shared consensus in their implementation is still far from being reached. Additionally, vestibular impairment generally develops in these patients, as an acute or chronic loss of function, and it may negatively affect overall patient balance and therefore quality of life. The loss of function of a vestibular nerve is difficult to restore, but efforts have been made in vestibular rehabilitation to restore acceptable balance in these patients.

This Special Issue is thus dedicated to hearing and balance in vestibular schwannoma, which represent the frontier challenges in the management in these tumors, especially small ones. Topics will be centered on diagnostic and therapeutic aspects, including within the frame of long-term outcome and rehabilitation. Topics of interest include but are not limited to:

Audiological assessment and rehabilitation
- Hearing preservation surgery;
- Hearing rehabilitation strategies after loss of function;
- Outcomes in long-term perspective;
- Impact of hearing loss due to VS on daily life activities;
Vestibular assessment and rehabilitation
- Vestibular assessment in patients with VS;
- Implication of vestibular function on overall balance;
- Rehabilitation after surgery.

It is our hope that this Special Issue will offer a valuable contribution to the preservation and rehabilitation of function in the current management of vestibular schwannoma.

Dr. Elisabetta Zanoletti
Dr. Niccolo Favaretto
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Audiology Research is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

vestibular schwannoma
vestibular assessment
vestibular rehabilitation
hearing rehabilitation
audiological assessment
hearing preservation
vestibular

Published Papers (11 papers)

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Research

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11 pages, 835 KiB

Open AccessArticle

Cochlear Implantation Following Transcanal Infrapromontorial Approach for Vestibular Schwannoma: A Case Series

by Virginia Dallari, Enrico Apa, Daniele Monzani, Elisabetta Genovese, Daniele Marchioni, Davide Soloperto and Luca Sacchetto

Audiol. Res. 2023, 13(1), 1-11; https://doi.org/10.3390/audiolres13010001 - 21 Dec 2022

Viewed by 1827

Abstract

Background: Cochlear implantation (CI) following endoscopic transcanal infrapromontorial vestibular schwannoma (VS) dissection is a feasible intervention in intracanalicular VS, with minimal extension into the cerebellopontine angle, but no audiologic results have ever been reported in the literature. Methods: From 2015 to 2021 in the Otorhynolaryngology Departments of Modena and Verona, three patients underwent this intervention. All were suffering from sporadic left-sided intracanalicular Koos I VS. Intraoperative electrically evoked auditory brainstem responses and electrophysiological measurements were performed before and after the placement of the electrode array, respectively. Since device activation one month after the surgery, each patient was followed up with audiometric tests, data logging, electrode impedance measurements and neural response telemetry performed at each scheduled fitting session at 15 days and 3, 6, 12 and 24 months. Results: Only in patient No. 3, an auditory benefit was observed and still evident even 36 months after activation. Impedances increased progressively in patient No. 1 and a benefit was never reported. Patient No. 2 left the follow-up for worsening comorbidities. Conclusions: CI following transcanal infrapromontorial VS resection is a beneficial intervention. The residual cochlear nerve after the tumour dissection and the course of electrophysiological measurements in the postoperative period were the main predictive factors for audiological outcomes. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

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9 pages, 248 KiB

Open AccessEditor’s ChoiceArticle

Postoperative Impact of Pontocerebellar Angle Surgery on the Quality of Life in Patients with Vestibular Schwannoma

by Valentina Foscolo, Luigi de Gennaro, Alessandra Murri, Luca Speranzon, Francesco Signorelli, Nicola Quaranta and Raffaella Messina

Audiol. Res. 2022, 12(6), 635-643; https://doi.org/10.3390/audiolres12060061 - 17 Nov 2022

Cited by 5 | Viewed by 1719

Abstract

Background: Vestibular Schwannomas are benign tumors arising from the VIII CN. Surgical treatment is indicated in case of tumors larger than 2.5 cm in the cerebellopontine angle or in the case of cranial nerve dysfunction. The aim of the present study was to evaluate the QoL by means of the PANQOL questionnaire in a group of surgically treated patients mainly affected by large and giant VS Methods: All patients underwent preoperative and postoperative otoneurological evaluation and gadolinium enhanced MRI and they completed, independently, the PANQOL questionnaire at last follow up. Results: 70% of patients presented with large Koos III or IV VS Each domain of PANQOL showed a strong correlation with the total PANQOL score. In relation to the postoperative facial nerve function, patients with poorer function showed significantly lower score in the facial dysfunction and pain, patients with postoperative balance problems showed a significantly lower PANQOL score for domains of balance and pain. Conclusions: This study showed that postoperative QoL of patients was acceptable even if there were some domains that were more affected, such as hearing and balance domains; therefore, the lowest scores suggest the need for vestibular rehabilitation programs and strategies that improve postoperative hearing. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

Review

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9 pages, 272 KiB

Open AccessReview

Hearing Aid in Vestibular-Schwannoma-Related Hearing Loss: A Review

by Valerio Maria Di Pasquale Fiasca, Flavia Sorrentino, Martina Conti, Giulia De Lucia, Patrizia Trevisi, Cosimo de Filippis, Elisabetta Zanoletti and Davide Brotto

Audiol. Res. 2023, 13(4), 627-635; https://doi.org/10.3390/audiolres13040054 - 8 Aug 2023

Viewed by 1366

Abstract

(1) Background: Several types of hearing aids are available for the rehabilitation of vestibular-schwannoma (VS)-related hearing loss. There is a lack of recently published papers regarding this theme. The aim of the present work is to organize current knowledge. (2) Methods: A review of the literature regarding the topics “vestibular schwannoma”, “hearing loss”, and “hearing aid” was performed. Nineteen studies were thus considered. (3) Results: Conventional hearing aids, contralateral routing of signal (CROS) aids, bone anchored hearing aids (BAHA), and others are available options for hearing rehabilitation in VS patients. The speech discrimination score (SDS) is considered the best measure to assess candidacy for rehabilitation with hearing aids. The best hearing rehabilitative conditions in VS patients when using conventional hearing aid devices are a mild−moderate hearing loss degree with good word recognition (more than 50% SDS). CROS-Aid and BAHA are reported to be beneficial. CROS-Aid expands on the area of receiving hearing. BAHA aids use direct bone-conduction stimulation. Unfortunately, there are no available studies focused specifically on VS patients that compare CROS and BAHA technologies. (4) Conclusions: Hearing aids, CROS, and BAHA are viable options for rehabilitating hearing impairment in VS, but require an accurate case-by-case audiological evaluation for rehabilitating hearing impairment in VS. Further studies are needed to prove if what is currently known about similar hearing illnesses can be confirmed, particularly in the case of VS. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

11 pages, 274 KiB

Open AccessReview

Prognostic Factors for Hearing Preservation Surgery in Small Vestibular Schwannoma

by Stefano Concheri, Alessandra Deretti, Giulia Tealdo and Elisabetta Zanoletti

Audiol. Res. 2023, 13(4), 473-483; https://doi.org/10.3390/audiolres13040042 - 3 Jul 2023

Cited by 1 | Viewed by 1454

Abstract

Objective: to evaluate recent contributions to the literature on prognostic factors of hearing preservation in small vestibular schwannoma microsurgery. Methods: review of the most recent studies. Results: factors such as tumor size, preoperative hearing status, tumor growth rate, tumor origin, surgical approach, radiological characteristics, results of preoperative neurophysiological tests, preoperative symptoms and demographic features have been investigated and some of them reported to be significant in the prediction of hearing preservation. Conclusions: tumor size and preoperative hearing status are the most impactful factors and play a key role in patient selection for hearing preservation surgery. Other features such as fundal extension, tumor origin and impaired ABR could have prognostic value on hearing preservation. Tumor growth rate, preoperative impedance, cVEMPs and age have also recently been found to be significant, but more studies are needed. The role of preoperative tinnitus, vertigo and gender is lacking and controversial, whereas the differences between available surgical approaches have been smoothed out in recent years. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

10 pages, 247 KiB

Open AccessReview

Intraoperative Cochlear Nerve Monitoring in Cochlear Implantation after Vestibular Schwannoma Resection

by Valerio Maria Di Pasquale Fiasca and Giulia Tealdo

Audiol. Res. 2023, 13(3), 398-407; https://doi.org/10.3390/audiolres13030035 - 30 May 2023

Cited by 3 | Viewed by 1482

Abstract

Background: The use of a cochlear implant (CI) for hearing rehabilitation after vestibular schwannoma (VS) resection is widely spreading. The procedure is usually performed simultaneously to tumor resection with a translabyrinthine approach. To ensure the best device function, assessing the integrity of the cochlear nerve is of primary importance. Methods: A narrative review of the literature on the present topic was carried out up to June 2022. Finally, nine studies were considered. Results: Electrically evoked auditory brainstem responses (eABR) is the most widely used method of intraoperative monitoring of cochlear nerve (CN) during VS resection, although its limits are known. It can be assessed through the CI electrode array or through an intracochlear test electrode (ITE). Variations of the graph are evaluated during the surgical procedure, in particular the wave V amplitude and latency. As tumor dissection progresses, the parameters may change, informing of the CN status, and the surgical procedure may be modulated. Conclusion: An eABR positive result seems to be reliably correlated with a good CI outcome in those cases in which a clear wave V is recorded before and after tumor removal. On the contrary, in those cases in which the eABR is lost or altered during the surgical procedure, the positioning of a CI is still debatable. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

10 pages, 1717 KiB

Open AccessReview

Hearing Rehabilitation in Vestibular Schwannoma

by Gauri Mankekar and Sean Holmes

Audiol. Res. 2023, 13(3), 357-366; https://doi.org/10.3390/audiolres13030031 - 12 May 2023

Cited by 1 | Viewed by 2176

Abstract

The most common complaint among patients with vestibular schwannoma (VS) is hearing loss. This significantly affects the quality of life before, during, and after treatment for patients with VS. Untreated hearing loss in VS patients may even lead to depression and feelings of social isolation. A variety of devices are available for hearing rehabilitation for patients with vestibular schwannoma. These include contralateral routing of hearing signals (CROSs), bone-anchored hearing devices, auditory brainstem implants (ABI), and cochlear implants. In the United States, ABI is approved for patients 12 years of age and older with neurofibromatosis type 2. In the past few years, cochlear implantation has been offered simultaneously or sequentially with tumor resection or irradiation, or even to patients whose VS have been monitored with serial imaging. However, determining the functional integrity of the auditory nerve in patients with vestibular schwannoma is a challenge. This review article consists of (1) the pathophysiology of vestibular schwannoma (VS), (2) hearing loss in VS, (3) treatment of VS and associated hearing loss, (4) options for auditory rehabilitation in patients with VS with their individual benefits and limitations, and (5) challenges in hearing rehabilitation in this cohort of patients to determine auditory nerve functionality. (6) Future directions. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

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19 pages, 353 KiB

Open AccessReview

Vestibular Impairment in Patients with Vestibular Schwannoma: A Journey through the Pitfalls of Current Literature

by Davide Pisani, Federico Maria Gioacchini, Giuseppe Chiarella, Alessia Astorina, Filippo Ricciardiello, Alfonso Scarpa, Massimo Re and Pasquale Viola

Audiol. Res. 2023, 13(2), 285-303; https://doi.org/10.3390/audiolres13020025 - 13 Apr 2023

Cited by 2 | Viewed by 1960

Abstract

Vestibular Schwannoma is the most common tumour of Ponto Cerebellar Angle and is capable of strongly impacting the patient’s quality of life. In recent decades, the proposals for the management of the disease have multiplied, just as the diagnostic capacity has improved. While in the past, the primary objective was the preservation of the facial function, and subsequently also of the auditory function, the attention to the vestibular symptomatology, which appears to be one of the main indicators of deterioration of quality of life, is still unsatisfactory. Many authors have tried to provide guidance on the best possible management strategy, but a universally recognized guideline is still lacking. This article offers an overview of the disease and the proposals which have advanced in the last twenty years, evaluating their qualities and defects in a critical reading. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

16 pages, 1973 KiB

Open AccessEditor’s ChoiceReview

Cochlear Implantation in Intralabyrinthine Schwannoma: Case Series and Systematic Review of the Literature

by Sebastiano Franchella, Marzia Ariano, Francesca Bevilacqua, Stefano Concheri and Elisabetta Zanoletti

Audiol. Res. 2023, 13(2), 169-184; https://doi.org/10.3390/audiolres13020017 - 28 Feb 2023

Cited by 4 | Viewed by 1614

Abstract

Intralabyrinthine schwannomas (ILS) are rare benign tumours arising from the peripheral branches of the cochlear or vestibular nerves in the membranous labyrinth, intracochlear schwannomas being the most frequent ones. When hearing is no longer feasible on the affected side, surgical removal along with simultaneous cochlear implantation can be proposed to the patient. We hereby present a systematic review of the literature on the topic, as well as two original cases from our centre (Ospedale Università degli Studi di Padova). Cochlear implantation in intracochlear schwannomas is feasible, with overall satisfactory hearing outcomes in accordance with the evidence found in the literature. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

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14 pages, 536 KiB

Open AccessReview

How Cochlear Implant Rehabilitation Impacts the Therapeutic Strategy for Vestibular Schwannoma

by Francesco P. Iannacone, Francesca Visconti and Elisabetta Zanoletti

Audiol. Res. 2023, 13(1), 116-129; https://doi.org/10.3390/audiolres13010012 - 8 Feb 2023

Cited by 4 | Viewed by 1962

Abstract

Background: Since both surgery and more conservative treatments show long-term outcomes in patients with VS, the current challenge in its therapeutic strategy is to offer a cure with lower functional morbidity in terms of facial and hearing preservation or the possibility of hearing rehabilitation with a cochlear implant. Methods: PubMed and Scopus databases were searched from 2017 to November 2022. Fifteen articles met our selection criteria: (1) patients with a diagnosis of VS, either sporadic or NF2-related; (2) simultaneous or sequential cochlear implantation; (3) specified audiological test results and follow-up timing. Conclusions: Although the level of evidence for the presently included studies is low due to either the study design or the lack of treatment consensus, CI rehabilitation is a promising option, especially in small VS with compromised hearing and as a salvage option after a failed attempt at hearing preservation surgery. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

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13 pages, 619 KiB

Open AccessEditor’s ChoiceReview

Intra-Operative Cochlear Nerve Function Monitoring in Hearing Preservation Surgery: A Systematic Review of the Literature

by Marzia Ariano, Sebastiano Franchella, Giulia Tealdo and Elisabetta Zanoletti

Audiol. Res. 2022, 12(6), 696-708; https://doi.org/10.3390/audiolres12060066 - 15 Dec 2022

Cited by 3 | Viewed by 1582

Abstract

With the recent scientific and technical developments, hearing preservation surgery is becoming a growing objective in inner ear pathologies, especially for vestibular schwannomas. In this review, we aim to describe the pros and cons of the following cochlear nerve monitoring techniques: ABRs (auditory brainstem responses), DENM (direct eighth cranial nerve monitoring), EcochG (electrocochleography), CNAP (cochlear compound nerve action potentials), DPOAE (distortion product otoacoustic emissions), PAMRs (postauricular muscle responses). The Cochrane library, Scopus, DynaMed, and PubMed databases were screened to obtain any relevant papers from October 2009 to the present day. Due to the heterogeneity of the existing studies in the literature, there is no way to tell whether a technique is better than another. All authors reported satisfactory outcomes with the cochlear nerve monitoring techniques tested, either alone or in combination. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

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Other

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10 pages, 5490 KiB

Open AccessCase Report

Paroxysmal Positional Nystagmus in Acoustic Neuroma Patients

by Francesco Comacchio, Paola Magnavita and Barbara Bellemo

Audiol. Res. 2023, 13(2), 304-313; https://doi.org/10.3390/audiolres13020026 - 13 Apr 2023

Viewed by 1483

Abstract

The association between acoustic neuroma and positional vertigo with paroxysmal positional nystagmus is relatively rare, but, when present, it certainly represents a challenge for the otoneurologist. There are few reports in the literature on this particular issue, and some questions are still unanswered, particularly regarding the characteristics of positional nystagmus that may distinguish between a true benign paroxysmal vertigo and a positional nystagmus associated with the tumor. We present the videonystagmographic patterns of seven patients with acoustic tumor who had paroxysmal positional nystagmus and analyzed its features. A concomitant true benign paroxysmal positional vertigo may be present during the follow-up of a non-treated patient, as the paroxysmal positional vertigo may be the first symptom of the tumor, and it may show characteristics that are very similar to a posterior semicircular canal canalolithiasis or a horizontal canal “heavy or light cupula”. The possible mechanisms are discussed. Full article

(This article belongs to the Special Issue Hearing and Balance in Acoustic Neuroma)

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