The Outcome of Vestibular Nerve Section for Intractable Vertigo: The Patient's Point of View

Abstract

To document the outcome of vestibular nerve section from the patient's point of view we reviewed 102 patients who had undergone vestibular nerve section 1 to 10 years after operation. Only 3 patients had experienced further vertigo attacks: 2 of these were cured by a further, this time translabyrinthine vestibular nerve section; 1 patient developed multiple sclerosis. In contrast, about 50% of patients developed some subjective problem with balance while standing or walking; in 15% it was present all the time and of moderate severity. Despite this, over 85% of patients reported that they felt much better or back to normal after the operation and were satisfied with the outcome. The development and application of objective preoperative measures of vestibular and, in particular, vestibulospinal function might improve patient selection for vestibular nerve section and thus reduce the number of dissatisfied patients.

Results of Electrocochleography in Ménière’s Disease after Successful Vertigo Control by Single Intratympanic Gentamicin Injection

“…Recently it has been shown, in animal experiments as well as in humans, that a single ITP-G injection causes partial damage and loss of vestibular hair cells, but preserves enough hair cell synaptic activity to retain the spontaneous discharge and/or rotational sensitivity of afferents [Carey et al, 2002;Hirvonen et al, 2005]. Apparently, this reduction in peripheral vestibular sensitivity is sufficient to inhibit pathological fluctuations of afferent input, but gentle enough not to provoke the symptoms of chronic vestibular insufficiency, elicited in 20% of cases with unilateral vestibular loss [Reid et al, 1996;Badke et al, 2002]. This could make ITP-G administration an ideal candidate for the therapy in severe MD.…”

Spatial orientation in patients with chronic unilateral vestibular hypofunction is ipsilesionally distorted

“…This is usually achieved by central compensatory mechanisms including re-weighting of multisensory (vestibular, somatosensory, visual) input (Angelaki et al , 2008, Sadeghi et al , 2010 and by minimizing the vestibular tone imbalance between the affected and the healthy side (Halmagyi et al , 2010), as the vestibular nerve remains hypofunctional in the majority of cases. Whereas compensation allows about 80% of patients to resume normal activities of daily life (Reid et al , 1996, Halmagyi et al , 2010, these mechanisms are insufficient to compensate for fast movements, causing brief spells of vertigo and oscillopsia during rapid head movements (Okinaka et al , 1993, Halmagyi et al , 2010.…”

Vestibular compensation following vestibular neurotomy

“…To avoid a poor result, vestibular nerve sectioning must be complete, on whatever approach: supratemporal, [4], retrolabyrinthine [5] or retrosigmoid [6]. Although neurotomy abolishes vertigo in 90% of cases [6,7], 10% of patients show residual instability despite unilateral vestibular areflexia [8,9], due to poor vestibular compensation. The present article reviewed studies of the mechanisms of vestibular compensation using various methods of analysis in MD patients who had undergone UVN.…”