Intralabyrinthine schwannomas are a small subset of vestibular schwannomas which originate within the labyrinthine structures. Management typically consists of watch-and-wait strategies given that surgical intervention will sacrifice hearing. Endoscopic resection of primary intracochlear schwannoma
with simultaneous cochlear implantation for a patient with progressive hearing loss and debilitating tinnitus is described.
A 56-year-old male presenting with asymmetric left sensorineural hearing loss (SNHL) was diagnosed with intracochlear schwannoma
Surgery was indicated due to tumor growth on serial imaging, worsening SNHL, and severe tinnitus. Partial cochlectomy
was performed via transcanal endoscopic approach. Cochlear implantation via mastoidectomy and posterior tympanotomy was simultaneously performed with a CI512 Contour Advanced implant (Cochlear, Sydney, Australia).
Main Outcome Measures:
Post partial cochlectomy
Preoperative audiometry showed left profound SNHL with 20% speech recognition score despite maximal amplification. Speech perception testing 5 months postoperatively demonstrated good unilateral discrimination when testing the implanted ear alone (BKB sentences 66%, CUNY sentences 79%), open-set comprehension, and excellent binaural performance.
The endoscope offers an additional viable approach to the otic capsule for the removal of intracochlear schwannoma
and good audiologic outcomes can be achieved with simultaneous cochlear implantation even after partial cochlectomy