Simultaneous Endolymphatic Sac Decompression and Cochlear Implantation for Refractory Ménière's Disease With Advanced Hearing Loss

Introduction: Meniere's disease (MD) patients suffer from vertigo attacks and hearing loss. In advanced-refractory cases, the literature reports the use of simultaneous labyrinthectomy and cochlear implantation (CI) with good outcomes. However, this ablative procedure may result in secondary vestibulopathy and require rescue therapies. An alternative, organ sparing approach for such patients is simultaneous endolymphatic sac decompression with CI (ESD/CI). There is a paucity of literature exploring outcomes with this technique. The purpose of this study was to review preliminary outcomes with ESD/CI at a single tertiary academic institution.

Methods: MD patients who underwent simultaneous ESD/CI were retrospectively reviewed from 2017-present. For inclusion, patients had to demonstrate: ≥1 vertigo attack/week, supportive vestibular test results, SNHL meeting FDA/Medicare criteria for CI in the diseased ear, negative MRI, and average daily sodium intake of 1200-1500mg for three months prior to surgery. Patients who previously received intra-tympanic therapy were considered. Demographic variables, hearing ability of the non-operated ear, operative findings, complications, and hearing/vestibular outcomes were collected.

Results: A total of 6 patients/7 procedures were reviewed. Mean age was 65.3 years. Of them, 5 patients met CI criteria in the operated ear with variable asymmetric SNHL in the opposite ear. Only 1 patient had SSD. All patients underwent trans-mastoid decompression of the endolymphatic sac/duct without shunt. Of the total, 5 patients received perimodiolar electrodes, 1 received a lateral wall electrode. Cochlear preservation technique was utilized in all patients. Mean postop vertigo attacks declined from 4/mo to 0.16/mo. 2 patients have experienced no further attacks. All patients improved their AZBIO-quiet scores from preop. No patients needed rescue treatment/vestibular rehab. Mean follow up was 10 months.

Conclusions: ESD/CI was safe and effective. Patients achieved good vestibular/hearing outcomes without rescue interventions. Further study of this technique is warranted. Operative video will be presented.