Cochlear Implantation Outcomes in Patients With Sporadic Inner Ear Schwannomas With and Without Simultaneous Tumor Resection.

OBJECTIVES: Describe a single institution's cochlear implant outcomes for patients with inner ear schwannomas (IES) in the setting of various tumor management strategies (observation, surgical resection, or stereotactic radiosurgery [SRS]). STUDY DESIGN: Single-institution retrospective review. PATIENTS: Patients diagnosed with isolated, sporadic IES who underwent cochlear implantation (CI). INTERVENTIONS: CI with or without IES treatment. MAIN OUTCOME MEASURES: Speech perception outcomes, tumor status. RESULTS: Twelve patients with IES underwent CI with a median audiologic and radiologic follow-up of 12 months. Six patients underwent complete resection of the tumor at the time of CI, four underwent tumor observation, and two underwent SRS before CI. At 1 year after CI for all patients, the median consonant-nucleus-consonant (CNC) word score was 55% (interquartile range, 44-73%), and the median AzBio sentence in quiet score was 77% (interquartile range, 68-93%). Overall, those with surgical resection performed similarly to those with tumor observation (CNC 58 versus 61%; AzBio in quiet 74 versus 91%, respectively). Patients who underwent tumor resection before implantation had a wider range of speech performance outcomes compared with patients who underwent tumor observation. Two patients had SRS treatment before CI (10 months previous and same-day as CI) with CNC word scores of 6 and 40%, respectively. CONCLUSIONS: Patients with IES who underwent CI demonstrated similar speech performance outcomes (CNC 56% and AzBio 82%), when compared with the general cochlear implant population. Patients who underwent either tumor observation or surgical resection performed well after CI.

Full Recovery of Hearing After Resection of a Large Epidermoid Tumor at the Cerebellopontine Angle: 2-Dimensional Operative Video.

Epidermoid tumors are benign, slow-growing lesions, originating from misplaced ectodermal cells that become trapped during neural tube closure.1 The cerebellopontine angle (CPA) is the most common intracranial location for epidermoid tumors, accounting for approximately 60% of cases.2 Treatment of epidermoid tumors consists of surgical resection, with the goal of gross total resection.3 Here, we describe the case of a patient with a large epidermoid tumor at the CPA causing near-complete hearing loss, who remarkably experienced full recovery of hearing after resection of the tumor. The patient is a 37-year-old woman who presented to our clinic with a CPA tumor causing severe hearing loss consisting of class D hearing and a word recognition score of 5% on audiological examination. Radiographically, the tumor demonstrated significant mass effect on the right cranial nerves VII and VIII with prominent extension into the internal auditory canal. Given the patient's profound hearing loss, she consented to receive a right retrosigmoid craniotomy for resection of the lesion. Although cranial nerves VII and VIII were heavily invested in the tumor, we were able to systematically resect the lesion from the CPA and internal auditory canal, and achieve a gross total resection. Histological examination confirmed the diagnosis of an epidermoid tumor. Remarkably, the patient's audiogram at 3-month follow-up demonstrated complete recovery of hearing in her right ear with a word recognition score of 100% and normal hearing sensitivity across all tested frequencies.

Current Estimate of Hearing Aid Utilization in the United States.

Objective: To present key data from a private marketing report that characterizes US hearing aid (HA) utilization, HA candidate and user population sizes, and HA pricing. Patients: HA candidates and users in the United States. Interventions: Hearing amplification. Main Outcome Measures: HA utilization, HA candidate and user population sizes, HA market size and value, and HA pricing. Results: In 2015, an estimated 8.5 million HA users accounted for a total of 15.4 million individual HA devices in the United States. Approximately 81% of HA users owned bilateral devices. In 2015, approximately 87% of devices were purchased as replacements by current HA users, while the remaining 13% of devices were purchased by new HA users. HA utilization rates among the candidate population approximated 21% in 2015, which was stable over the 3-year study period. In 2015, there was a net increase of 696,060 individuals who met HA candidacy criteria but did not undergo treatment with HAs, adding to the backlog of 31.0 million untreated HA candidates who existed before that year. The HA market was valued at $6.0 billion in 2015, with an average retail selling price of $1798 per device ($3596 per pair). In the same year, the average manufacturer selling price was $495 per device ($990 per pair), or nearly 1 quarter of the retail price. Conclusions: HAs are substantially under-utilized in the United States with an annually growing backlog of untreated HA candidates.