Sequential Bilateral Cochlear Implantation in a Patient with Bilateral Ménière’s Disease

Abstract

This case study describes a 45 year old female with bilateral, profound sensorineural hearing loss due to Meniere’s disease. She received her first cochlear implant in the right ear in 2008 and the second cochlear implant in the left ear in 2010. The case study examines the enhancement to speech recognition, particularly in noise, provided by bilateral cochlear implants. Speech recognition tests were administered prior to obtaining the second implant and at a number of test intervals following activation of the second device. Speech recognition in quiet and noise as well as localization abilities were assessed in several conditions to determine bilateral benefit and performance differences between ears. The results of the speech recognition testing indicated a substantial improvement in the patient’s ability to understand speech in noise and her ability to localize sound when using bilateral cochlear implants compared to using a unilateral implant or an implant and a hearing aid. In addition, the patient reported considerable improvement in her ability to communicate in daily life when using bilateral implants versus a unilateral implant. This case suggests that cochlear implantation is a viable option for patients who have lost their hearing to Meniere’s disease even when a number of medical treatments and surgical interventions have been performed to control vertigo. In the case presented, bilateral cochlear implantation was necessary for this patient to communicate successfully at home and at work.

Cochlear Implantation in Ménière’s Disease

“…A review of the available literature revealed that only a handful of English-language articles investigating CI in the setting of MD have been published. [4][5][6][7][8] Most of these are single case reports and opinion articles and focus primarily on the effects of CI on hearing performance in patients with MD. Only 1 study has addressed the effects of CI on the nonhearing aspects of MD.…”

Cochlear Implant Impedance Fluctuation in Ménière's Disease

“…Such variations are unlikely to be attributed to electrode differences as both were the contour design from the same manufacturer and insertions were performed by the same surgeon using the same technique with no post-op complications. Such variations are also unlikely to be attributed to duration of deafness (another point of difference between ears), as binaural sequential CI has been well documented in the research and no article to date has reported a similar pattern of asymmetrical impedance fluctuation (4,7,10).…”

“…Despite hearing fluctuation, studies have shown that hearing aids are beneficial to alleviate hearing loss (2,3) but as the disease progresses they become less effective and many patients become eligible for cochlear implant (CI). Studies have shown that CI can successfully rehabilitate hearing in patients with MD who meet the audiological criteria for candidacy (4)(5)(6)(7).…”

Ménière’s Disease with Concomitant Vestibular Migraine

“…Cochlear implantation prohibits transtympanic injections for Ménière's disease treatment due to the electrode blocking access to the round window membrane. Surgical planning can also become more complex in patients who need cochlear implant surgery combined with vertigo control surgery, such as endolymphatic sac surgery [ 52 ]. Although simultaneous labyrinthectomy and cochlear implantation has been used successfully in unilateral Ménière's disease patients, the authors prefer cochlear implantation combined with non-ablative endolymphatic sac surgery in this patient population (MDVM) at higher risk for bilateral Ménière's disease [ 53 ].…”