Navigating Options to Save His Hearing


Kenneth Posner
Ken Posner

Ken Posner has always had a love for music, so when he was faced with the very real possibility of going deaf in one ear due to his vestibular schwannoma diagnosis, he found himself distressed.

Ken's story begins in January 2009, when he experienced intermittent ringing in his right ear (tinnitus) for about a week. A sufferer of chronic migraines, Ken shared his concerns with his headache specialist in Chicago. Ken’s doctor ordered an MRI, which demonstrated a small vestibular schwannoma in Ken’s right internal auditory canal.

Vestibular schwannomas, also called acoustic neuromas, are benign tumors, usually slow growing, that commonly originate on the 8th cranial nerve leading from the brain to the ear. The first symptoms can include hearing loss, balance problems, and tinnitus.

“The diagnosis of something growing inside my head was very troubling to me. I felt the need to learn as much as I could about my diagnosis and treatment options in order to make the best decision about how to proceed,” says Ken.

The more he learned, however, the more confused he found himself.

“I was presented with two very different options, radiation or surgery, and I had no idea which path to take. Some doctors adamantly advocated for radiation, while others rejected radiation and pushed for surgical removal. None of the doctors gave any credibility to the other approaches," says Ken.

“An ear specialist who I knew and trusted told me that I must have the tumor surgically removed using the translabyrinthine (translab) approach," Ken says. The translab approach involves entering the auditory nerve canal through the mastoid bone behind the ear. This technique allows for complete removal of the tumor while minimizing risk of injury to the facial nerve and facial paralysis, but it always results in a complete loss of hearing in the affected ear. "The thought of being deaf in one ear terrified me."

“I also spoke with a neurosurgeon in Chicago who told me that radiation treatment was the only way to proceed, because surgery for vestibular schwannomas would soon be obsolete.”

Growing even more confused, Ken was unsure how to resolve these contradictory recommendations. Furthermore, the physicians who recommended radiation couldn't tell him how much hearing loss he would suffer following treatment.

To help him make a decision, Ken looked for a surgeon who used both radiation and surgery to treat vestibular schwannomas. "I figured that a doctor who practiced both forms of treatment could tell me which was the best choice for me," says Ken.

Dr. B. Gregory Thompson
Dr. B. Gregory Thompson

This lead him to the office of B. Gregory Thompson, M.D., a neurosurgeon here at the University of Michigan Health System and a member of the UMHS multidisciplinary acoustic neuroma program.

“I’ll never forget my first appointment with Dr. Thompson. He gave my wife and me his full attention," says Ken. "Although the appointment started late, Dr. Thompson did not allow this to compromise the visit. At dinner time, he received a phone call from his family. I asked if he needed to leave, and he told me no, that he wasn’t leaving until he had answered all of our questions. He wasn’t kidding; we were there for another hour. It meant a lot to us."

Dr. Thompson explained that the UMHS acoustic neuroma program that is comprised of members from both the Departments of Neurosurgery and Otolaryngology-Head and Neck Surgery. This team has perfected a newer surgical technique, called the middle fossa approach, that not only removes the tumor but also gives patients the chance to preserve their hearing. Given Ken’s overall good health and goal of hearing preservation, Dr. Thompson recommended he pursue this option.

Ken went on to meet with neurotologist and surgeon Steven A. Telian, M.D., to learn more about the middle fossa technique. Dr. Telian explained that by approaching the tumor from above the ear, he and Dr. Thompson would have access to remove the tumor in a way that allows preservation of the auditory and facial nerves. This approach boasts an 80 percent success rate for removing small tumors with good hearing remaining in the ear.

“It was actually Dr. Telian who really made the decision clear to me,” says Kenneth. “I asked him how someone like me, without medical training, should go about making the decision between the risks and benefits of surgery versus the risks and benefits of radiation. He explained that with surgery, we will know the results and can manage them, whereas with radiation, it would take time to fully realize the effects of the treatment. Dr. Telian added that even if I chose radiation, he would still be my doctor and would treat any resulting hearing loss. His commitment was enough for me. I wanted to take the more definitive approach with a doctor who practiced that kind of devotion, so I decided to move forward with surgery."

In April 2009, Ken underwent a middle fossa resection of his right vestibular schwannoma with great success. Drs. Telian and Thompson were able to preserve Ken's hearing, much to his delight, and he made a splendid recovery.

Today Ken is approaching five years post-surgery and doing remarkably well. With his full hearing preserved, Ken has been able to sing in a choir. Recently, he joined a community band and is playing his trumpet again for the first time since college.

“It’s remarkable, really, to be able to continue to enjoy music,” Ken says. “I can’t thank the Michigan team enough.”

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