[Cochlear implantation in Ménière's disease]

Menière's disease is a chronic inner ear disorder characterized by recurrent vertigo attacks, tinnitus, and fluctuating hearing loss, which may progress to severe sensorineural hearing impairment in a subset of patients. Since 2015, international consensus criteria distinguish between definite and probable disease. Current therapeutic strategies follow a stepwise approach, ranging from non-ablative to ablative interventions. Cochlear implantation (CI) has emerged as an effective option for auditory rehabilitation and has also shown beneficial effects on vertigo and tinnitus. Combined strategies with endolymphatic sac surgery are discussed, while labyrinthectomy with simultaneous CI represents a highly effective yet irreversible intervention. Particular challenges arise in bilateral cases, where radiological endotyping (e.g., hypoplastic vestibular aqueduct type) may improve future treatment planning. Evidence demonstrates that CI is feasible after ablative procedures as well as in unilateral Menière's disease with hearing preservation, resulting in significant improvements in quality of life. Systematic reviews confirm the safety and efficacy of CI, establishing its central role in the management of advanced disease stages. Early developments of vestibulocochlear implants (VCI) additionally open perspectives for combined auditory and vestibular rehabilitation, although clinical application remains experimental.