Treatment of an acoustic neuroma in an only-hearing ear: case reports and considerations for the future

Current options regarding the treatment of acoustic neuroma in an only-hearing ear include: observation, attempted hearing preservation surgery, and stereotactically guided radiation therapy. A patient who had a left labyrinthectomy for Menière's disease presented 15 years later with a large right acoustic neuroma. Due to anticipated profound deafness, he fit the criteria for cochlear implantation. Promontory stimulation of the left ear was positive. He underwent successful left cochlear implantation with the Nucleus 22-channel device and was successfully rehabilitated. He then underwent translabyrinthine removal of his right-sided 2.5-cm acoustic neuroma. This case is used to illustrate a new option available to those faced with treating a patient with acoustic neuroma in an only-hearing ear. How this approach may fit in with other available options will be discussed.