Acoustic neuroma surgery with cochlear implant restores woman’s hearing

In the summer of 2022, the sound in Elizabeth “Nikki” Lacobie’s left ear became muffled. When Nikki’s ears did not clear after antibiotic treatment, her doctors investigated further.

An MRI revealed that she had a rare, but benign brain tumor called an acoustic neuroma. Acoustic neuromas are usually located on the vestibular nerve, which is responsible for balance and motion and runs alongside the cochlear nerve responsible for hearing. Though not cancerous, these tumors can still become dangerous if they grow too large and press against the nerves and brainstem, causing problems with balance and, most commonly, hearing loss.

Since Nikki’s tumor was only 5 mm, doctors recommended leaving it alone because the traditional method of removing acoustic neuromas involves going through the labyrinth, the organ that processes balance. This causes deafness in the affected ear, as well as problems with word recognition and disorientation in noisy environments. Removing the acoustic neuroma could have a major impact on Nikki’s quality of life.

However, in January 2023, her symptoms worsened as she started experiencing mild facial paralysis. In February, a 5K race left her feeling severely nauseated and dizzy; by March, a follow-up MRI revealed that the tumor had doubled in size and Nikki’s ability to recognize words had dropped to about 70%.

A sense of comfort and hope at MD Anderson

Fortunately, head and neck surgeon Paul Gidley, M.D., and neurosurgeon Franco DeMonte, M.D., at MD Anderson were now investigating combining cochlear implants into the same operation when removing acoustic neuromas.

After consulting various doctors in both Louisiana and Houston, Nikki felt comfortable enough to put her trust in the hands of Drs. Gidley and DeMonte, with the hopes of having their team remove her tumor while having a chance at restoring the inevitable hearing loss.

“I felt like everybody was looking out for me, and I’m glad they were as confident and as skilled as they were,” Nikki says. “This was the team that needed to take care of me.”

While cochlear implants have been available for complete hearing loss in both ears, it was only in 2019 that the Food and Drug Administration (FDA) approved its use for single-sided hearing loss.

Because Nikki’s cochlear nerve was still intact and her tumor was still relatively small, she was a prime candidate to have the device placed at the same time as her surgery.

“With the implant, we can stimulate hearing and measure brainwave responses to that,” Gidley says. “So, it helps guide the tumor removal.”

Cochlear implant restores hearing and word recognition with training

In July 2023, Nikki underwent surgery to place a cochlear implant, allowing the doctors to then completely remove her tumor while preserving the cochlear nerve.

Three weeks later, her implant was activated. It took a while for Nikki to get used to the unnatural sounds generated in her brain by the device stimulating the cochlear nerve directly. This process bypasses the usual method of hearing via the cochlea that filters pitches and frequencies.

“I didn’t know what to expect on that first day,” Nikki says. “I just feel like it had a robotic, electronic kind of sound.”

When she wears the cochlear implant, it also quiets down the tinnitus, or constant ringing in her ear, that usually comes with single-sided deafness. Nikki also had to re-train her brain through a series of exercises, including some where she heard music sent to her implant via Bluetooth while reading the accompanying lyrics and putting the words and sounds together in a new way.

“I’ve always heard that you don’t appreciate what you have until it’s missing,” Nikki says. “I was nervous as to whether or not the implant would actually take, but I was excited when it definitely did. I understand it’s going to be different from what I had before and I’m making some lifestyle changes, but I’m doing well.”

After only a few months, the tumor was confirmed to be completely gone and her word recognition was back to nearly 97%. Her balance is much better, and her facial movement is intact.

Nikki is one of only a few patients who has benefited from this procedure. It is still in the early stages, and doctors continue to investigate what makes someone a good candidate. But successful outcomes like Nikki’s provide hope that this can improve the lives of more patients.

“We have essentially restored hearing and given them back something that the tumor had taken away,” DeMonte says. “That’s something I never thought I’d see in my lifetime.”

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