Hearing and Vestibular Outcomes in Patients Undergoing Labyrinthectomy and Cochlear Implant in End-Stage Menière's Disease.

Abstract

Objective: To analyze the results of hearing, vertigo, and tinnitus after simultaneous or sequential labyrinthectomy and cochlear implant (CI) and evaluate the effectiveness of end-stage Menière's disease (MD) treatment.

Study design: Retrospective study.

Method: The medical records of 39 patients who underwent labyrinthectomy and CI ipsilaterally for intractable vertigo and hearing loss with preoperative and postoperative documents were evaluated. Auditory outcomes were assessed with pure tone and speech audiometry (word test, closed set) and compared with the preoperative audiometric evaluation. Dizziness was graded according to the Dizziness Handicap Inventory Questionnaire (DHI). Tinnitus outcomes were assessed by the Tinnitus Handicap Inventory (THI).

Results: Paired t tests revealed significant improvements in post-CI pure tone average (p = 0.0001), speech discrimination (p = 0.009), and tinnitus (p = 0.0001). Fifty-eight percent of patients had complete resolution of the vestibular symptoms in the operated ear, while 42% showed little or no improvement. However, over half (54.5%) of the patients with no or partial improvement were over 65 years old, as evidenced by the postoperative DHI. Patients demonstrated significant reductions in tinnitus as indicated by a significant improvement on the THI (p = 0.0001).

Conclusion: Patients with vertigo and profound hearing loss who have end-stage Menière's disease (MD) or secondary Menière's disease can benefit from labyrinthectomy with a cochlear implant (CI). Older individuals should be treated with caution due to the possibility of chronic instability. Cochlear implantation greatly benefits both tinnitus suppression and hearing restoration.