Simultaneous Cochlear Implantation and Labyrinthine Surgery for Meniere Disease: Endolymphatic Sac Decompression Versus Labyrinthectomy

Introduction: Patients with medically refractory Meniére disease (MD) may present with concomitant vertigo attacks and severe-profound hearing loss (SNHL). In such cases, simultaneous labyrinthectomy/cochlear implantation (CI) is a viable treatment option. Simultaneous endolymphatic sac decompression (ESD) and CI is less well described but represents a promising alternative. This study aims to analyze outcomes after simultaneous or staged ESD/CI as compared with simultaneous labyrinthectomy/CI. Materials and methods: MD patients undergoing simultaneous or staged ESD/CI and simultaneous labyrinthectomy/CI were reviewed from 2 tertiary care centers. Inclusion criteria included: ≥ 2 vertigo attacks/week, supportive vestibular testing, normal MRI, SNHL meeting criteria for CI, and average sodium intake of 1200 to 1500 mg/day. Demographic data, surgical complications, audiometric outcomes, and vestibular outcomes were analyzed. Results: Eighteen patients (19 ears) were included. Six patients (7 ears) underwent either simultaneous or staged ESD/CI, and 12 patients (12 ears) underwent labyrinthectomy/CI. Vertigo attacks decreased in 71.4% of ESD/CI patients and 100% of labyrinthectomy/CI patients. 6/7 ears in the ESD/CI cohort had improved AzBio sentence scores with an average improvement of 85.6% in quiet, 64.8% in +10 SNR, ( P <0.05), and 77.5% improvement in monosyllabic word scores ( P <0.05). Of the 9 patients in the labyrinthectomy/CI cohort with adequate data, 7 showed improved AzBio-Q sentence scores with an average improvement of 57.6% ( P <0.05) at the most recent follow-up. Conclusions: Simultaneous ESD/CI was safe and effective. Vestibular and hearing outcomes after this approach were comparable to those associated with labyrinthectomy/CI. ESD/CI may be associated with a lower rate of vertigo resolution than labyrinthectomy/CI. Level of Evidence: Level IV, retrospective case series.