Abstract
Background
Surgical management of Ménière’s disease (MD) is recommended in case of medical and intratympanic treatment failures. Translabyrinthine vestibular nerve section has been considered the gold standard for denervation procedures in order to control vertigo attacks, although at the cost of sacrificing residual hearing. To the best of our knowledge, no work has been published with regard to a group of patients submitted to translabyrinthine vestibular neurectomy and simultaneous cochlear implant for MD. The aim of the present study was to assess the effectiveness of translabyrinthine vestibular nerve section and simultaneous cochlear implant in a prospective study.
Methods
All adult patients (over 18 years of age) with a diagnosis of intractable unilateral definite MD and useless residual hearing function were enrolled after medical and intratympanic treatment failures. Pre- and postoperative otoneurological evaluation concerned: frequency of vertigo attacks, head impulse test and caloric testing, pure tone average and speech perception audiometry in quiet conditions, tinnitus handicap inventory test, functional level scale and rate of vertigo control, dizziness handicap inventory test, and MD patient-oriented severity index. At least 6 months of follow-up were needed to be enrolled in the study.
Results
Four patients were included in the study. Translabyrinthine vestibular nerve section and simultaneous cochlear implant seemed to considerably improve the disabling effects of MD, achieving a good control of vestibular symptoms (mean pre/postoperative vertigo attacks per month: 16.5/0), resolving hearing loss (mean pre/postoperative pure tone average in the affected ear: 86.2/32.5 dB), improving the tinnitus (mean pre/postoperative tinnitus handicap inventory test: 77.2/6), and finally increasing the overall quality-of-life parameters.
Conclusions
In our preliminary report, translabyrinthine vestibular nerve section and simultaneous cochlear implant showed encouraging results in order to definitively control both vestibular and cochlear symptoms during the same therapeutic procedure.
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References
Aksoy S, Firat Y, Alpar R (2007) The Tinnitus Handicap Inventory: a study of validity and reliability. Int Tinnitus J 13:94–98
Albera R, Canale A, Parandero F, Ducati A, Lanotte M (2011) Surgical indication in Ménière’s disease therapy: clinical and epidemiological aspects. Eur Arch Otorhinolaryngol 268:967–972
Basura GJ, Lin GC, Telian SA (2014) Comparison of second-echelon treatments for Ménière’s disease. JAMA Otolaryngol Head Neck Surg 140:754–761
Berryhill W, Graham M (2002) Chemical and physical labyrinthectomy for Ménière’s disease. Otolaryngol Clin N Am 35:675–682
Brandt T, Strupp M, Dieterich M (2016) Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome. J Neurol 263:90–96
Bretlau P, Thomsen J, Tos M, Johnsen NJ (1989) Placebo effect in surgery for Ménière’s disease: nine-year follow-up. Am J Otol 10:259–261
Brookes G (1997) The role of vestibular nerve section in Ménière’s disease. Ear Nose Throat J 76:652–656, 658–659, 663
Casani AP, Cerchiai N, Navari E, Dallan I, Piaggi P, Sellari-Franceschini S (2014) Intratympanic gentamicin for Ménière’s disease: short- and long-term follow-up of two regimens of treatment. Otolaryngol Head Neck Surg 150:847–852
Casani AP, Piaggi P, Cerchiai N, Seccia V, Sellari-Franceschini S, Dallan I (2012) Intratympanic treatment of intractable unilateral Ménière disease: gentamicin or dexamethasone? A randomized controlled trial. Otolaryngol Head Neck Surg 146:430–437
Committee on Hearing and Equilibrium (1995) Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Ménière’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 113:181–185
Dandy W (1928) Ménière’s disease: its diagnosis and a method of treatment. Arch Surg 16:1127–1152
Dandy W (1941) The surgical treatment of Ménière’s disease. Surg Gynecol Obstet 72:421–425
De la Cruz A, Teufert KB, Berliner KI (2007) Transmastoid labyrinthectomy versus translabyrinthine vestibular nerve section: does cutting the vestibular nerve make a difference in outcome? Otol Neurotol 28:801–808
Deveze A, Bernard-Demanze L, Xavier F, Lavieille J-P, Elziere M (2014) Vestibular compensation and vestibular rehabilitation. Current concepts and new trends. Neurophysiol Clin 44:49–57
Duracinsky M, Mosnier I, Bouccara D, Sterkers O, Chassany O (2007) Literature review of questionnaires assessing vertigo and dizziness, and their impact on patients’ quality of life. Value Health 10:273–284
Eddington DK, Dobelle WH, Brackmann DE, Mladejovsky MG, Parkin JL (1978) Auditory prostheses research with multiple channel intracochlear stimulation in man. Ann Otol Rhinol Laryngol 87:1–39
Fisch U (1996) Transtemporal supralabyrinthine (middle cranial fossa) vestibular neurectomy: a review of the last 100 cases. Skull Base Surg 6:221–225
Fujita N, Nario K, Yamanaka T, Ueda T, Matsunaga T (1998) Neurovascular compression syndrome with Ménière’s disease—a report of the treatment of a patient with microvascular decompression. Auris Nasus Larynx 25:203–207
Furukawa M, Kitahara T, Horii A, Uno A, Imai T, Ohta Y, Morihana T, Inohara H, Mishiro Y, Sakagami M (2013) Psychological condition in patients with intractable Ménière’s disease. Acta Otolaryngol 133:584–589
Gates G, Verrall A (2005) Validation of the Ménière’s disease patient-oriented symptom-severity index. Arch Otolaryngol Head Neck Surg 131:863–867
Gates GA (2000) Clinimetrics of Ménière’s disease. Laryngoscope 110:8–11
Ghossaini S, Wazen J (2006) An update on the surgical treatment of Ménière’s diseases. J Am Acad Audiol 17:38–44
Glasscock M, Nashville T (1973) Vestibular nerve section. Middle fossa and translabyrinthine. Arch Otolaryngol 97:112–114
Glasscock ME, Hughes GB, Davis WE, Jackson CG (1984) Labyrinthectomy versus middle fossa vestibular nerve section in Ménière’s disease. A critical evaluation of relief of vertigo. Ann Otol Rhinol Laryngol 89:318–324
Glasscock ME, Jackson CG, Poe DS, Johnson GD (1989) What I think of sac surgery in 1989. Am J Otol 10:230–233
Hansen MR, Gantz BJ, Dunn C (2013) Outcomes after cochlear implantation for patients with single-sided deafness, including those with recalcitrant Ménière’s disease. Otol Neurotol 34:1681–1687
Holden LK, Neely JG, Gotter BD, Mispagel KM, Firszt JB (2012) Sequential bilateral cochlear implantation in a patient with bilateral Ménière’s disease. J Am Acad Audiol 23:256–268
Huang TS (1987) Valve implants compared to other surgical methods. Am J Otol 8:301–306
Huang TS (1999) Three new surgeries for treatment of intractable Ménière’s disease. Am J Otol 20:233–237
Jacobson G, Newman CW (1990) The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 116:424–427
Jennings R, Reams C, Jacobson J, Cole J (1989) Results of surgical treatment for Ménière’s disease. Otolaryngol Head Neck Surg 100:195–199
Jung TT, Anderson JH, Paparella MM (1987) Cochleovestibular nerve sections in labyrinthectomized patients. Am J Otol 8:155–158
Kaylie DM, Jackson CG, Gardner EK (2005) Surgical management of Ménière’s disease in the era of gentamicin. Otolaryngol Head Neck Surg 132:443–450
Kveton JF (2006) Revision surgery for vertigo. Otolaryngol Clin N Am 39:741–750
Langman AW, Lindeman RC (1993) Surgery for vertigo in the nonserviceable hearing ear: transmastoid labyrinthectomy or translabyrinthine vestibular nerve section. Laryngoscope 103:1321–1325
Lassaletta L, Aristegui M, Medina M, Aranguez G, Pérez-Mora RM, Falcioni M, Gavilán J, Piazza P, Sanna M (2014) Ipsilateral cochlear implantation in patients with sporadic vestibular schwannoma in the only or best hearing ear and in patients with NF2. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-014-3450-3
Levine SC (2002) Vestibular nerve section. Oper Tech Otolaryngol Head Neck Surg 12:137–140
Levine SC, Glasscock M, McKennan KX (1990) Long-term results of labyrinthectomy. Laryngoscope 100:125–127
Linthicum FH, Alonso A, Denia A (1979) Traumatic neuroma: a complication of transcanal labyrinthectomy. Arch Otolaryngol 105:654–655
Lloyd SK, Glynn FJ, Rutherford SA, King AT, Mawman DJ, O’Driscoll MP, Evans DG, Ramsden RT, Freeman SR (2014) Ipsilateral cochlear implantation after cochlear nerve preserving vestibular schwannoma surgery in patients with neurofibromatosis type 2. Otol Neurotol 35:43–51
Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A, Classification Committee of the Barany Society, Japan Society for Equilibrium Research, European Academy of Otology and Neurotology (EAONO), Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), Korean Balance Society (2015) Diagnostic criteria for Ménière’s disease. J Vestib Res 25:1–7
Lustig LR, Yeagle J, Niparko JK, Minor LB (2003) Cochlear implantation in patients with bilateral Ménière’s syndrome. Otol Neurotol 24:397–403
MacKeith SAC, Bottrill ID, Ramsden JD (2014) Simultaneous labyrinthectomy with cochlear implantation in patients with bilateral Ménière’s disease. Ann Otol Rhinol Laryngol 123:485–489
Mancini F, Catalani M, Carru M, Monti B (2002) History of Ménière’s disease and its clinical presentation. Otolaryngol Clin N Am 35:565–580
Mick P, Amoodi H, Arnoldner C, Shipp D, Friesen L, Lin V, Nedzelski J, Chen J (2014) Cochlear implantation in patients with advanced Ménière’s disease. Otol Neurotol 35:1172–1178
Møller AR, Møller MB (2007) Microvascular decompression operations. Prog Brain Res 166:397–400
Møller MB, Møller AR, Jannetta PJ, Jho HD, Sekhar LN (1993) Microvascular decompression of the eighth nerve in patients with disabling positional vertigo: selection criteria and operative results in 207 patients. Acta Neurochir (Wien) 125:75–82
Monsell EM, Brackmann DE, Linthicum FH (1988) Why do vestibular destructive procedures sometimes fail? Otolaryngol Head Neck Surg 99:472–479
Monzani D, Genovese E, Marrara A, Gherpelli C, **ani L, Forghieri M, Rigatelli M, Guadagnin T, Arslan E (2008) Validity of the Italian adaptation of the Tinnitus Handicap Inventory; focus on quality of life and psychological distress in tinnitus sufferers. Acta Otorhinolaryngol Ital 28:126–134
Murphy M, Gates G (1999) Measuring the effects of Ménière’s disease: results of the Patient-Oriented Severity Index (MD POSI) version 1. Ann Otol Rhinol Laryngol 108:331–337
Nelson R (2001) Translabyrinthine vestibular neurectomy. In: Brackmann DE, Shelton C, Arriaga MA (eds) Otologic surgery, 2nd edn. WB Saunders, Philadelphia, pp 433–439
Newman CW, Jacobson GP, Spitzer JB (1996) Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg 122:143–148
Norré M, Forrez G, Beckers A (1987) Vestibular dysfunction causing instability in aged patients. Acta Otolaryngol 104:50–55
Ozdoğmuş O, Sezen O, Kubilay U, Saka E, Duman U, San T, Cavdar S (2004) Connections between the facial, vestibular and cochlear nerve bundles within the internal auditory canal. J Anat 205:65–75
Paparella MM, Fina M (2002) Endolymphatic sac enhancement: reversal of pathogenesis. Otolaryngol Clin N Am 35:621–637
Pappas DG (1997) Vestibular nerve section: long term follow-up. Laryngoscope 107:1203–1209
Portmann G (1927) The saccus endolymphaticus and an operation for draining for the relief of vertigo. R Soc Med 20:1862–1867
Pullens B, Verschuur HP, Van Benthem PP (2013) Surgery for Ménière’s disease. Cochrane Database Syst Rev 2:1–19
Quaglieri S, Gatti O, Rebecchi E, Manfrin M, Tinelli C, Mira E, Benazzo M (2014) Intratympanic gentamicin treatment “as needed” for Ménière’s disease. Long-term analysis using the Kaplan–Meier method. Eur Arch Otorhinolaryngol 271:1443–1449
Rauch S (2010) Clinical hints and precipitating factors in patients suffering from Ménière’s disease. Otolaryngol Clin N Am 43:1011–1017
Reid CB, Eisenberg R, Halmagyi GM, Fagan PA (1996) The outcome of vestibular nerve section for intractable vertigo: the patient’s point of view. Laryngoscope 106:1553–1556
Sajjadi H, Paparella MM (2008) Ménière’s disease. Lancet 372:406–414
Schuknecht H (1956) Ablation therapy for the relief of Ménière’s disease. Laryngoscope 66:859–870
Semaan MT, Megerian CA (2011) Ménière’s disease: a challenging and relentless disorder. Otolaryngol Clin N Am 44:383–403
Semaan MT, Zheng QY, Han F, Zheng Y, Yu H, Heaphy JC, Megerian CA (2013) Characterization of neuronal cell death in the spiral ganglia of a mouse model of endolymphatic hydrops. Otol Neurotol 34:559–569
Silverstein H, Jackson LE (2002) Vestibular nerve section. Otolaryngol Clin N Am 35:655–673
Silverstein H, Norrell H, Smouha E, Jones R, Rosenberg S (1990) An evolution of approach in vestibular neurectomy. Otolaryngol Head Neck Surg 102:374–381
Silverstein H, Smouha E, Jones R (1989) Natural history vs. surgery for Ménière’s disease. Otolaryngol Head Neck Surg 100:6–16
Sood AJ, Lambert PR, Nguyen SA, Meyer TA (2014) Endolymphatic sac surgery for Ménière’s disease: a systematic review and meta-analysis. Otol Neurotol 35:1033–1045
Stokroos R, Kingma H (2004) Selective vestibular ablation by intratympanic gentamicin in patients with unilateral active Ménière’s disease: a prospective, double-blind, placebo- controlled, randomized clinical trial. Acta Otolaryngol 124:172–175
Teufert KB, Berliner KI, De la Cruz A (2007) Persistent dizziness after surgical treatment of vertigo: an exploratory study of prognostic factors. Otol Neurotol 28:1056–1062
Teufert KB, Doherty J (2010) Endolymphatic sac shunt, labyrinthectomy, and vestibular nerve section in Ménière’s disease. Otolaryngol Clin N Am 43:1091–1111
Thomsen J, Bonding P, Becker B, Stage J, Tos M (1998) The non-specific effect of endolymphatic sac surgery in treatment of Ménière’s disease: a prospective, randomized controlled study comparing “classic” endolymphatic sac surgery with the insertion of a ventilating tube in the tympanic membrane. Acta Otolaryngol 118:769–773
Thomsen J, Bretlau P, Tos M, Johnsen NJ (1981) Placebo effect in surgery for Ménière’s disease. A double-blind, placebo-controlled study on endolymphatic sac shunt surgery. Arch Otolaryngol 107:271–277
Van de Heyning P, Vermeire K, Diebl M, Nopp P, Anderson I, De Ridder D (2008) Incapacitating unilateral tinnitus in single-sided deafness treated by cochlear implantation. Ann Otol Rhinol Laryngol 117:645–652
Vermeire K, Van Yper L, De Vel E, Dhooge I (2014) Is cochlear implantation an effective treatment for Ménière’s disease? B-ENT 10:93–98
Wareing M, O’Connor A (1997) The role of labyrinthectomy and cochlear implantation in Ménière’s disease. Ear Nose Throat J 76:664–672
Ylikoski J, Belal A (1981) Human vestibular nerve morphology and labyrinthectomy. Am J Otolaryngol 2:81–93
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Canzi, P., Manfrin, M., Perotti, M. et al. Translabyrinthine vestibular neurectomy and simultaneous cochlear implant for Ménière’s disease. Acta Neurochir 159, 123–130 (2017). https://doi.org/10.1007/s00701-016-2996-9
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DOI: https://doi.org/10.1007/s00701-016-2996-9