Cochlear Implantation in Ménière's Disease With and Without Labyrinthectomy

Abstract

Objective: To investigate outcomes of cochlear implantation (CI) in patients with Ménière's disease (MD) with and without surgical labyrinthectomy. Study Design: Retrospective study. Setting: Multiple tertiary referral centers. Subjects: Thirty one ears from 27 patients (17 men, 10 women, aged 42–84) with CI in ipsilateral MD ear. Intervention: CI in ears with intact labyrinths (Group 1), CI with simultaneous surgical labyrinthectomy (Group 2), and CI sequential to surgical labyrinthectomy (Group 3). Main Outcome Measure: Within-subject improvement on Bamford Kowal Bench test or City University of New York open set sentence tests. Results: Majority of ears achieved excellent open-set speech recognition by 12 months post-CI, irrespective of intervention group. Preoperative details including patient age and sex, implant, MD and previous intervention, and audiological test results did not significantly affect outcomes. Patients with MD undergoing CI only may experience vestibular dysfunction which may cause long-term concerns. Incidental finding was noted of eight ears with fluctuating symptoms in ipsilateral ear during 12-month period post-CI, with five of eight ears showing objective fluctuating impedances and mapping. Conclusion: CI in MD can yield good hearing outcomes in all three groups and this is possible even after a long delay after labyrinthectomy. Bilateral MD patients are complex and prospective quality of life (QoL) measures would be beneficial in being better able to manage the vestibular outcomes as well as the audiological ones.

Cochlear implantation in Meniere’s disease: surgery and outcomes

“…One disadvantage of simultaneous labyrinthectomy and CI is that patients with residual hearing preoperatively will not experience the full consequences of single sided deafness and may not fully appreciate the benefit of the cochlear implant. 10 In a study by Vermeire et al, after CI, the hearing of all seven subjects improved significantly. 11 In a study by Heywood et al, in two patients with simultaneous labyrinthectomy and cochlear implantation, there was complete resolution of vertigo; speech perception in quiet and ability to hear in background noise improved considerably.…”

Simultaneous labyrinthectomy and cochlear implantation in unilateral meniere's disease

“…Investigations of cochlear implantation in Meniere's disease patients have demonstrated successful auditory rehabilitation in this and other studies. 24,26,27 Simultaneous labyrinthectomy and cochlear implantation provides many benefits, including the benefit of an ablative and restorative procedure under a single general anesthetic, restoration of binaural hearing, and the potential elimination of vertigo and tinnitus. Notably, all of our patients had complete resolution of their tinnitus.…”

“…Previous studies have demonstrated successful audiologic rehabilitation of Meniere's disease patients with cochlear implantation . Simultaneous labyrinthectomy and cochlear implantation in patients with Meniere's disease provide a unique opportunity to address intractable vertigo and restore auditory perception in a deafened ear.…”

“…[18][19][20][21][22] Previous studies have demonstrated successful audiologic rehabilitation of Meniere's disease patients with cochlear implantation. [23][24][25][26][27] Simultaneous labyrinthectomy and cochlear implantation in patients with Meniere's disease provide a unique opportunity to address intractable vertigo and restore auditory perception in a deafened ear. Previous investigation of outcomes following simultaneous labyrinthectomy and cochlear implantation in Meniere's disease patients have either been retrospective case studies, focused on bilateral disease, or part of a larger cohort.…”

Surgical Procedures for Ménière’s Disease

“…In 2015, in a comparative study [53] between cochlear sacculotomy techniques and endolymphatic sac decompression, the control of vertigo was significantly better in patients after cochleo-sacculotomy but also with significant deterioration of hearing. The cochleo-sacculotomy procedure performed simultaneously with cochlear implant surgery in patients with deafness and persistent vertigo in Ménière's disease is an alternative already proposed by some authors [54][55][56], and they have reported good results.…”