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Cochlear Implantation in Ménière's Disease With and Without Labyrinthectomy
Payal Mukherjee1, Kate Eykamp, Daniel Brown
1*RPA Institute of Academic Surgery †Healthy Hearing and Balance Care ‡Brian and Mind Research Institute §Vestibular Research Laboratory, School of Psychology, The University of Sydney ||St. Vincent's Hospital ¶Sydney Cochlear Implant Centre, Sydney, Australia.
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.
