Vestibulometric Efficacy Evaluation of Simultaneous Endolymphatic Sac Drainage and Cochlear Implantation in Patients with Meniere’s Disease
2Department for Diagnosics and Rehabilitation of Hearing Impairments, Saint Petersburg ENT and Speech Research Institute, Russian Federation
Background: At advanced stage of Meniere’s disease alleviation of vertigo spells as well as auditory function and binaural input restoration could be reached by means of simultaneous performance of endolymphatic sac drainage (ESD) and cochlear implantation (CI).
Methods: Four patients diagnosed with Meniere’s disease with bilateral profound hearing loss underwent simultaneous ESD and CI. In all the cases Meniere’s disease was refractory to medical treatment; none of the patients had undergone any ear surgery previously.
Pursuit eye movements, spontaneous nystagmus, cortical and subcortical optokinetic nystagmus (OKN) were recorded and measured with the use of computerized videooculography. Deviations of gravity center in the sensory organization test (SOT) were recorded and automatically analyzed with the help of computerized dynamic posturography. These computerized methods of vestibulometry were performed preoperatively and in postoperative follow-up period.
Results: During the primary examination horizontal spontaneous nystagmus was revealed in 2 cases without gaze fixation. In all the cases stable integrity of central vestibular pathways was demonstrated by smoothness of pursuit eye movements and regularity of OKN. In long-term postoperative period spontaneous nystagmus was not elicited. Average absolute asymmetry of subcortical OKN decreased by 26 in long-term postoperative period. Average absolute asymmetry of cortical OKN went down by 13 in the same time span. Composite equilibrium score in SOT increased on average by 19 in long-term postoperative period.
Audiologic performance correlated with those who had underwent CI for profound sensorineural hearing loss and not suffered from Meniere’s disease.
Conclusion: Simultaneous endolymphatic sac drainage and cochlear implantation could be considered as a viable option for patients at advanced stage of Meniere’s disease with profound hearing loss as this technique enables dramatic vertigo spells alleviation as well as residual hearing preservation.
Basing on complex vestibulometric investigation signs of vestibular function compensation were revealed in all patients in long-term postoperative period.
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