Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P101

Oral Presentations	

Incidence of Vestibular Schwannoma in the
United States: How Demographics Will
Lead to Increases by 2060
Daniel Bu, MD (Presenter); Sean Neifert; Zachary G.
Schwam; Vivian F. Kaul; George B. Wanna, MD; Maura
Cosetti, MD
Objectives: The incidence of vestibular schwannoma has
been increasing over the years because of improvements in
magnetic resonance imaging sensitivity, although this has not
resulted in a corresponding increase in surgical volume. This
is due to more stringent criteria for resection candidacy and an
evolving ethos on who stands to benefit most. Trends in incidence and demographic changes through 2060 may affect the
number of vestibular schwannomas; herein we project the
number and change in volume of vestibular schwannoma hospitalizations between the years 2020 and 2060.
Methods: Complete National Inpatient Sample records from
2003 to 2016 (accounting for nearly 500 million hospitalizations)
were used in conjunction with US Census Bureau data to quantify and project rates of hospitalization for acoustic neuromas as
a function of census area, age group, and sex. Poisson regression
modeling based on these admission rates was used to formulate
projections in the US population between 2020 and 2060.
Results: Over the next 40 years, the number of hospitalizations for vestibular schwannoma is expected to increase by
23%, from 2358 to 2898 cases per year. The rate of increase is

driven by patients >65 years, with the incidence expected to
increase by 50%. However, the bulk of vestibular schwannomas will continue to be found in those aged 55 to 64 years,
with a minimal change expected until 2060.
Conclusions: The volume of vestibular schwannoma hospitalizations is projected to increase significantly between 2020
and 2060, most of which is expected in the elderly population.
Increasing burden of disease has implications for resource utilization and improved treatment paradigms.
The Influence of Age, Body Mass Index, and
Frailty on 30-Day Vestibular Schwannoma
Surgical Complications
Khodayar Goshtasbi (Presenter); Mehdi Abouzari, MD; Sina
Soltanzadeh-Zarandi; Brooke Sarna; Harrison W. Lin, MD;
Hamid R. Djalilian, MD
Objectives: To evaluate whether increased body mass index
(BMI), age, or frailty influences 30-day postoperative complications following vestibular schwannoma (VS) surgery.
Methods: The 2005 to 2017 National Surgical Quality
Improvement Program database was queried for patients with
VS undergoing surgical resection. Frailty score (0-5) was based
on dependent functional status, diabetes, chronic obstructive
pulmonary disease, congestive heart failure, and hypertension.
Results: A total of 1405 patients were included consisting of
56.7% women with a mean age of 51 ± 14 years and mean
BMI of 29 ± 7. When stratifying patients according to age
<50, 50 to 64, and ≥65 years, mean time of surgery (428 minutes vs 392 minutes vs 387 minutes; P < .001) and 30-day
mortality rates (0.7% vs 0% vs 1.8%; P = .01) were significantly different, whereas postoperative length of stay (LOS; P
= .16), readmission (P = .08), reoperation (P = .54), and complication rates were similar. When stratifying patients according to BMI <30 and ≥30, postoperative myocardial infarction
(P = .03) and wound infection (P = .02) were more commonly
observed in the obese cohort, but readmission (P = .18), reoperation (P = .44), and complication rates were similar.
Morbidly obese patients (BMI ≥35) also had higher rates of
deep vein thrombosis (P = .004). Lastly, frailty scores 0, 1,
and 2 to 4 were associated with LOS (4.7 ± 3.5 days vs 5.3 ±
4.1 days vs 6.7 ± 6.6 days, P < .001) and prolonged intubation
rates (1.0% vs 2.4% vs 3.7%; P = .03).
Conclusions: In a large cohort of patients with VS undergoing surgical resection, increased age, BMI, and frailty score
can be associated with different postoperative complication
rates, operation time, or LOS. Patients with higher age, BMI,
and frailty score should be counseled differently on surgical
complication rates.
Is Preoperative Vestibular Testing
Necessary in Cochlear Implant Candidates?
Neil S. Nayak, MD (Presenter); Jack J. Wazen, MD
Objectives: Cochlear implantation has been shown to reduce
vestibular function postoperatively in the implanted ear. The

Otology/Neurotology

caused by limitations in cochlear morphology. With recent
advances in long-electrode array design, this study sought to
investigate (1) the incidence of complete insertions among
patients implanted with a long flexible lateral wall array and
(2) morphological factors associated with partial insertion.
Methods: A retrospective review was conducted of adult CI
recipients of a 31.5-mm flexible lateral wall array at a tertiary
referral center between July 2018 and December 2019.
Postoperative computed tomography was reviewed to determine the rate of complete insertion, defined as all contacts
being intracochlear. Cochlear duct length (CDL) and angular
insertion depth (AID) were compared between partial and
complete insertion cohorts.
Results: Of 51 cases, most had a complete insertion (96.1%,
n = 49). Among cases of complete insertion, the median CDL
was 33.5 mm (range, 30.3-37.9 mm) and median AID was
643° (range, 500°-751°). The 2 cases of partial insertion had
relatively short CDL (31.8 mm and 32.3 mm) and shallow
AID (542° and 575°); across all cases, these values were at or
below the 15th percentile. Relatively shallow AID for the
2 cases of partial insertion fail to support the idea that CDL
alone prevents a complete insertion.
Conclusions: Complete insertion of a 31.5-mm flexible array
is feasible in most cases and does not appear to be limited by
CDL. Future studies are needed to estimate other variations in
cochlear morphology, such as cross-sectional diameter of the
scala tympani, which could predict resistance and failure to
achieve complete insertion of a long array.

P101
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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