title: Cochlear implantation following treatment for medulloblastoma.
abstract: OBJECTIVE
  Medulloblastoma is the most common pediatric malignant tumor of the central nervous system in children. Treatment includes surgical excision, external beam radiation, and multiagent chemotherapy. Otologic sequelae are common and may result from radiation and/or chemotherapy. Profound sensorineural hearing loss (SNHL) is a known complication of neuro-oncologic treatment and may render these patients eligible for cochlear implantation (CI). Issues of CI in this population, including diagnosis, treatment of preoperative middle ear disease, operative and postoperative course, performance data, and long-term tumor surveillance are highlighted and reviewed.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Three patients treated for pediatric medulloblastoma with surgical resection, postoperative hyperfractioned craniospinal radiotherapy, and multiagent adjuvant chemotherapy who underwent cochlear implantation were identified. Details of neuro-oncologic treatment and associated otologic complications are presented and analyzed. Primary outcome assessment includes treatment of middle ear pathology, perioperative cochlear implant course, and postimplantation performance data.
  
  
  RESULTS
  Each patient required surgical treatment of chronic ear disease 4 to 16 years after chemoradiation. All progressed to profound SNHL and were implanted 8 to 17 years post-neuro-oncologic treatment. There were no intraoperative complications, and full insertion of the cochlear implant electrode array was achieved in each patient. One patient developed postoperative wound dehiscence requiring operative closure. Postimplantation performance data support significant benefit in all patients.
  
  
  CONCLUSIONS
  Patients treated for pediatric medulloblastoma develop otologic sequelae, including profound SNHL, and may require cochlear implantation. Successful management of middle ear and mastoid pathology involves consideration of potential future cochlear implantation. Postoperative performance data supports cochlear implantation in this population.
authors.affiliation: Department of Otolaryngology, New York University Langone Medical Center, New York, New York, USA. tom.roland@med.nyu.edu
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Roland
authors.forename: Maura
authors.initials: M
authors.lastname: Cosetti
authors.forename: Tracey
authors.initials: T
authors.lastname: Liebman
authors.forename: Susan
authors.initials: S
authors.lastname: Waltzman
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation; D003131:Combined Modality Therapy; D006319:Hearing Loss, Sensorineural / Q000150:complications / Q000601:surgery*; D006801:Humans; D008527:Medulloblastoma / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome