Audiovestibular Outcomes After Parathyroidectomy in Primary Hyperparathyroidism

To prospectively evaluate audiovestibular outcomes following parathyroidectomy in patients with primary hyperparathyroidism (pHPT) using a comprehensive battery of audiological, vestibular, and patient-reported outcome measures.

This prospective observational study included 31 adult patients undergoing parathyroidectomy for pHPT caused by parathyroid adenoma. Assessments were performed preoperatively and at prespecified postoperative time points: audiometry at month 1; vHIT, VNG, and VDI at week 1 and month 1; and SVV on day 2, week 1, and month 1. The primary outcome was change in VDI score following surgery.

Hearing thresholds remained stable after surgery, with no significant changes in conventional or extended high-frequency audiometric measurements. SVV values remained within normal limits throughout follow-up, and VNG revealed no clinically significant abnormalities. vHIT gains were largely unchanged, although statistically significant differences were observed in left lateral canal gain (p = 0.032) and anterior canal asymmetry (p = 0.003); all values remained within normative ranges. Mean VDI scores improved significantly following surgery (38.1 ± 31.0 vs. 25.7 ± 26.8; p = 0.001), indicating reduced dizziness-related disability. None of the patients with preoperative BPPV (12.9%) reported recurrent positional vertigo symptoms during postoperative follow-up.

Parathyroidectomy was associated with significant improvement in subjective vestibular symptoms and reduced dizziness-related disability, despite largely stable objective audiological and vestibular findings. These results suggest that metabolic correction in pHPT may improve vestibular symptom perception through mechanisms not fully captured by conventional audiovestibular testing. Further studies with larger cohorts and longer follow-up are needed to clarify the long-term effects of parathyroidectomy on vestibular function.

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