Head & Neck Cancer & Cochlear Implants | Dr. Wu Hao (ENT) | CMCS Shanghai

About Dr. Wu Hao

Dr. Wu Hao is Chief of Otolaryngology at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine — China's national referral centre for hearing disorders and skull base surgery. He specialises in head and neck oncology, cochlear implantation, lateral skull base surgery, and auditory brainstem implantation. Dr. Wu is a pioneer in hearing restoration surgery in China and has led landmark multicentre studies on cochlear implant outcomes in complex post-tumour resection cases. His practice integrates surgical oncology with functional reconstruction — pursuing not merely biological cure, but quality-of-life restoration for every patient.

Case Overview

A 34-year-old piano teacher — whose professional identity and livelihood depended on her hearing — presented with a 3-year history of right-sided pulsatile tinnitus, 1 year of progressive hearing loss, and right facial numbness. High-resolution temporal bone CT and contrast-enhanced MRI demonstrated a Fisch Grade C jugular paraganglioma with the characteristic salt-and-pepper appearance, encasing the internal carotid artery and sigmoid sinus, invading the tympanic cavity and internal auditory canal base, and immediately adjacent to the cochlea and vertical facial nerve segment. Audiometry confirmed profound right-sided sensorineural hearing loss (pure tone average greater than 90 dB). Pre-operative DSA-guided tumour embolisation was performed to reduce intraoperative haemorrhage. Dr. Wu Hao then performed right lateral skull base resection with intraoperative facial nerve monitoring, followed immediately by round-window cochlear implantation — achieving tumour clearance, facial nerve preservation, and hearing reconstruction in a single operative session of 540 minutes. Post-operatively, facial nerve function was House-Brackmann Grade I. The cochlear implant was activated at 4 weeks; speech recognition in quiet reached 85%. At 1-year follow-up, no tumour recurrence was detected and the patient had returned to teaching.

Patient Background

• Age / Sex: 34-year-old female
• Occupation: Piano teacher at a conservatory of music — hearing is the foundation of her professional and personal identity
• Chief Complaint: Right-sided pulsatile tinnitus for 3 years; progressive hearing loss for 1 year; right facial numbness
• Medical History: No significant comorbidities
• Physical Examination: Right tympanic membrane deep blue in colour (haemotympanum sign — classic for glomus tumour); House-Brackmann Grade I facial function; right ear profound deafness (pure tone average greater than 90 dB); left ear hearing normal

Imaging and Diagnosis

High-Resolution Temporal Bone CT

• Right jugular foramen bone destruction; tumour invasion of the tympanic cavity and internal auditory canal base
• Fisch classification: Grade C — jugular paraganglioma with jugular foramen and petrous bone involvement (most surgically demanding subtype)

Contrast-Enhanced MRI

• Salt-and-pepper appearance: Classic signal pattern reflecting the tumour's dense vascularity — flow voids interspersed with haemorrhagic foci
• Tumour encasing the internal carotid artery and sigmoid sinus
• Immediate proximity to the cochlear basal turn and vertical facial nerve segment

Digital Subtraction Angiography (DSA)

• Primary tumour blood supply from the ascending pharyngeal artery
• Pre-operative embolisation performed to reduce intraoperative haemorrhage

Clinical Diagnosis

• Right jugular paraganglioma — Fisch Grade C
• Right profound sensorineural hearing loss

Clinical Decision Making

Jugular paragangliomas are highly vascular, deeply situated tumours. Conventional surgery has historically prioritised tumour removal at the cost of hearing and facial nerve function — leaving patients deaf, facially paralysed, or both. For a 34-year-old professional musician, conventional surgical outcomes would have meant the end of her career.

Dr. Wu Hao's integrated oncological and functional strategy: For a young patient with unilateral profound deafness and a normal contralateral ear, we cannot approach this as subtraction surgery alone — removing the tumour and accepting the functional consequences. We must add: resect the tumour completely, preserve the facial nerve with intraoperative monitoring, and simultaneously reconstruct hearing with cochlear implantation. The cochlea is already non-functional. But its anatomical structure can be preserved during tumour removal and immediately used as the implant recipient site. This is integrated skull base and hearing restoration surgery — one operation, three goals.

Surgical Procedure

Approach: Right lateral skull base tumour resection + facial nerve decompression + simultaneous cochlear implantation
Anaesthesia: General anaesthesia + intraoperative neurophysiological monitoring (IONM)
Operative time: 540 minutes
Estimated blood loss: 800 mL (controlled by pre-operative embolisation)

Step 1 — Fisch Incision and Exposure

A retroauricular question-mark incision was used, with anterior skin flap elevation exposing the mastoid, external auditory canal, and cervical vessels. Neuronavigation-guided localisation of the jugular bulb was confirmed before bone work commenced.

Step 2 — Tumour Resection and Facial Nerve Preservation (Critical Step)

Cervical vascular control: The internal jugular vein and internal carotid artery were identified and controlled in the neck before any intracranial dissection — providing immediate haemorrhage control if required during tumour removal.

Facial nerve skeletonisation: A piezoelectric ultrasonic bone cutter (Piezo) was used for selective bone removal along the facial nerve canal, exposing the vertical and labyrinthine segments in their entirety. The instrument's automatic deactivation on contact with soft tissue prevented inadvertent nerve sheath injury. Continuous facial nerve electromyography confirmed neural integrity at each stage of dissection.

Tumour removal: The highly vascular tumour was removed in piecemeal fashion. At the internal auditory canal base — where the tumour abutted the cochlear membranous labyrinth — dissection was performed with extreme precision to preserve the cochlear architecture, maintaining the structural integrity required for electrode insertion despite the cochlea's pre-existing functional loss.

Dr. Wu's operative note: Preserving a non-functional cochlea during tumour removal requires more discipline than simply removing it. Every instrument movement at the cochlear margin must be deliberate. We are not preserving hearing — we are preserving the anatomical substrate for hearing reconstruction. The cochlea is the implant recipient site. We treat it accordingly.

Step 3 — Cochlear Implantation (Innovative Step)

Following complete tumour resection and confirmation of a clean surgical field, Dr. Wu proceeded immediately to cochlear implantation within the same operative session.

Round window approach: Rather than performing cochleostomy (drilling a new opening in the cochlear bone wall), the electrode array was inserted gently through the round window membrane — the natural anatomical opening to the scala tympani. This approach preserves the cochlear bony architecture, minimises intracochlear trauma, and protects residual cochlear microstructure. The receiver-stimulator was secured beneath the temporalis muscle. Intraoperative X-ray confirmed correct electrode position within the cochlea.

Dr. Wu's operative note: The round window approach is not simply a technical preference — it is an oncological and audiological principle. In a cochlea that has been exposed to tumour and surgical dissection, minimising additional trauma during electrode insertion is essential. For patients with residual low-frequency hearing, this approach can preserve acoustic hearing alongside electrical stimulation — electro-acoustic stimulation. In this case, the cochlea was already profoundly deaf. But the technique we use here is the same technique that preserves hearing in patients who still have it.

Step 4 — Reconstruction and Closure

Abdominal fat was harvested and used to obliterate the surgical dead space, eliminating the risk of cerebrospinal fluid leak. The facial nerve was anatomically repositioned without grafting. Wound closure was performed in layers.

Pathology and Post-operative Recovery

Pathology Report

• Histology: Jugular paraganglioma (glomus jugulare); resection margins negative

Neurological Outcomes

• Facial nerve: House-Brackmann Grade I immediately post-operatively — complete normal function; no lagophthalmos
• Lower cranial nerves: Swallowing normal; voice normal — vagus nerve preserved

Hearing Reconstruction

• Cochlear implant activation (Switch-on): 4 weeks post-operatively
• Programming: Dr. Wu's team performed specialist MAP programming with frequency optimisation for music perception
• Outcomes: Environmental sound awareness restored immediately; speech recognition in quiet 85%; melody perception partially restored; normal conversational communication achieved

Follow-up and Quality of Life

• 1-year MRI: No tumour recurrence
• Professional rehabilitation: Patient returned to teaching — transitioning from performance instruction to music theory, enabling full professional re-engagement with students
• Psychological assessment: Anxiety and depression scores significantly reduced; patient reported being very satisfied with treatment outcomes
• Academic contribution: This case was enrolled in Dr. Wu's multicentre study on hearing reconstruction following lateral skull base tumour resection — contributing to the development of Chinese national standards for this procedure

Extended Case: Auditory Brainstem Implantation for Bilateral Deafness

Dr. Wu Hao's expertise in hearing restoration extends to the most challenging frontier in auditory surgery: cases where cochlear implantation is anatomically impossible.

A 22-year-old man with neurofibromatosis type 2 (NF2) had undergone bilateral vestibular schwannoma resection, resulting in complete bilateral deafness with absent cochlear nerves — precluding cochlear implantation. Dr. Wu performed auditory brainstem implantation (ABI) via a lateral skull base approach, placing the electrode array directly onto the cochlear nucleus complex of the brainstem. Post-operatively, the patient regained awareness of environmental sounds and achieved speech understanding with lip-reading support — emerging from a world of complete silence. ABI represents the summit of hearing restoration surgery: reconstructing auditory perception by bypassing the entire peripheral auditory system and interfacing directly with the central nervous system.

Expert Commentary — Dr. Wu Hao

1. Functional Cure Supersedes Biological Cure

The historical measure of success in skull base surgery was tumour removal. That standard is insufficient. For benign but locally aggressive tumours such as jugular paraganglioma, the surgical goal must be defined as tumour clearance plus organ function preservation plus quality-of-life restoration — simultaneously. A patient who is tumour-free but deaf and facially paralysed has received half a treatment. In this case, we achieved all three objectives in a single operation. That is the standard we hold ourselves to.

2. Cochlear Implantation as a Surgical Subspecialty

Cochlear implantation is no longer a standalone procedure performed in a clean operative field. It must be integrated into complex oncological and reconstructive surgery. The round window approach — inserting the electrode through the natural anatomical opening rather than drilling a new cochleostomy — minimises intracochlear trauma and preserves cochlear microstructure. For patients with residual low-frequency hearing, this technique enables electro-acoustic stimulation: the implant provides high-frequency electrical stimulation while the preserved acoustic pathway continues to transmit low-frequency sound. This is the frontier of cochlear implant surgery, and it requires surgeons who are equally competent in skull base oncology and implant technique.

3. Multimodal Monitoring as the Safety Net

Lateral skull base surgery is performed in one of the most anatomically unforgiving regions of the human body. Brainstem auditory evoked potentials (BAEP) and facial nerve electromyography (EMG) are not optional adjuncts — they are the intraoperative safety system. A 50% reduction in BAEP wave amplitude is our mandatory stop signal: all surgical activity ceases until the waveform recovers. This protocol has prevented irreversible neurological injury in cases where anatomical landmarks alone would have been insufficient. The monitoring does not replace surgical judgment. It extends it into dimensions the surgeon cannot directly perceive.

4. Whole-Journey Hearing Health Management

Surgery is the first step. Auditory-verbal rehabilitation — the systematic process of training the brain to interpret cochlear implant signals — is equally important and frequently underestimated. For musicians, standard rehabilitation protocols are insufficient: the brain must be retrained not only for speech perception but for pitch discrimination, timbre recognition, and melodic contour. Our centre provides specialist music rehabilitation programming for professional musicians receiving cochlear implants. As China's national hearing disorders centre, this comprehensive post-operative support is our responsibility — not an optional service.

How CMCS Shanghai Coordinated This Case

China Medical Concierge Shanghai (CMCS) supported this patient's care pathway from initial overseas inquiry through 1-year audiological follow-up. Our coordination included:

• Pre-arrival review of audiological reports, CT, and MRI imaging; specialist referral to Dr. Wu Hao's otolaryngology and skull base team at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University
• Arrangement of high-resolution temporal bone CT, contrast-enhanced MRI, DSA vascular mapping, and pre-operative tumour embolisation scheduling
• Bilingual interpretation during the surgical planning consultation, including detailed explanation of the Fisch Grade C classification, lateral skull base approach, facial nerve monitoring protocol, round-window cochlear implantation technique, and realistic hearing outcome expectations
• Pre-operative psychological preparation: patient counselling regarding the transition from bilateral acoustic hearing to unilateral cochlear implant hearing, and realistic discussion of music perception outcomes post-implantation
• Surgical admission logistics: hospital registration, skull base operative suite scheduling (requiring simultaneous otolaryngology and neurosurgical capability), and accommodation support for accompanying family
• On-site medical interpretation throughout the hospitalisation, including post-operative facial nerve assessment support and wound management guidance
• Cochlear implant activation coordination at 4 weeks: MAP programming appointment scheduling, specialist music frequency optimisation liaison with Dr. Wu's audiology team, and results communication to the patient's home audiologist
• Auditory-verbal rehabilitation coordination: specialist music rehabilitation programme enrolment, session scheduling, and progress monitoring over the first post-operative year
• 1-year surveillance coordination: MRI tumour surveillance scheduling, audiological reassessment, and communication with the patient's home ENT specialist for ongoing management

For international patients facing skull base tumours with associated hearing loss — particularly those who have been told that hearing preservation is impossible, or that simultaneous tumour resection and cochlear implantation cannot be performed — the combination of lateral skull base surgical expertise, intraoperative neurophysiological monitoring, and integrated cochlear implant capability at Shanghai's leading otolaryngology centres represents a standard of care that may not be available in their home country. CMCS exists to connect patients with that expertise: ensuring every functional preservation option is evaluated, every surgical risk is explained in their language, and every step from pre-operative embolisation to long-term audiological rehabilitation is coordinated with precision and care.

This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.