Labyrinthectomy and Cochlear Implantation in Patients With Meniere Disease: A Systematic Review.
Abstract
Objective
Ménière disease (MD) may progress to disabling vertigo and severe hearing loss despite conservative management. In patients with nonserviceable hearing, labyrinthectomy can provide effective vertigo control, while cochlear implantation (CI) offers the potential for auditory rehabilitation. This systematic review aimed to evaluate audiological, vestibular, tinnitus-related, and postoperative outcomes following labyrinthectomy combined with CI in patients with MD. DATABASES REVIEWED MEDLINE/PubMed, Scopus, and Embase.
Methods
A systematic review with qualitative synthesis was conducted in accordance with the PRISMA guidelines. Primary outcomes included postoperative speech audiometry and pure-tone average (PTA). Secondary outcomes included vertigo and dizziness control, Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI), and postoperative complications.
Results
Eight studies comprising 123 implanted ears met the inclusion criteria, including 3 cohort studies and 5 case series. Simultaneous labyrinthectomy and CI were reported in 7 studies, whereas 4 studies described sequential CI following prior labyrinthectomy. Audiological outcome reporting was heterogeneous and included PTA, Consonant-Nucleus-Consonant (CNC) or monosyllabic word recognition scores, AzBio sentence recognition, speech discrimination scores, and Bamford-Kowal-Bench (BKB)/City University of New York (CUNY) sentence tests. Most studies demonstrated measurable postoperative auditory benefit. DHI outcomes were reported in 3 studies and generally indicated low to mild residual dizziness-related handicap. THI outcomes, reported in 3 studies, suggested a low to mild residual tinnitus burden. Surgical complications were reported in 2 studies, while postoperative imbalance or recurrent vertigo was described in selected cohorts.
Conclusion
The combination of labyrinthectomy and CI could provide effective vertigo control while enabling meaningful auditory rehabilitation in carefully selected patients with advanced or treatment-refractory MD.