Cochlear Implantation and Vestibular Schwannoma Removal: The Gruppo Otologico Experience in 73 Consecutive Cases

BACKGROUND: Cochlear implantation (CI) following vestibular schwannoma (VS) resection, traditionally controversial, is increasingly accepted due to advances in surgical techniques. Current evidence is limited to small, short-term studies. This report presents the largest consecutive single-center cohort and offers long-term audiological outcomes. MATERIAL AND METHODS: This retrospective study analyzed 73 consecutive patients who underwent VS resection with either simultaneous (97%) or delayed (3%) CI at the Gruppo Otologico between 1985 and 2025, among more than 4000 patients who underwent VS removal during the same period. Sixty-three patients (86%) had sporadic VS, and 10 (14%) had neurofibromatosis type 2 (NF2). Tumor removal was performed using the enlarged translabyrinthine approach (ETLA). Outcomes were assessed through pure-tone average (PTA), speech discrimination scores (SDS), and open-set speech recognition. RESULTS: After a median 35-month follow-up, 48 patients (66%) were active CI users; 20 (27%) were nonusers or nonresponders. Five patients were "removed/non activated" (never activated due to postoperative complications or device malfunction or later explanted despite initial benefit) and were therefore not included in postoperative audiological outcome tables. Due to complications requiring explantation. Among users, the median postoperative PTA was 45.0 dB HL (IQR: 40.0-61.3), and the median SDS was 60.0% (IQR: 20.0-70.0). Open-set performance demonstrated high-to-median scores across word, sentence, and comprehension tests. Performance group analysis revealed that 52% of patients achieved intermediate-to-high outcomes, including 75% of NF2 patients. CONCLUSIONS: Performing CI immediately after VS resection is feasible and offers long-term functional benefits for most patients, including carefully selected NF2 cases. Although results can vary, more than half of the patients attain meaningful speech perception. This extensive, long-term, single-center experience strongly supports the feasibility of CI in this context, emphasizing the importance of surgical technique, nerve preservation, and precise patient selection.