Our findings indicate that the more conservative surgical procedures--endolymphatic sac surgery, cochleosacculotomy, and streptomycin perfusion--are all as effective as and less destructive than labyrinthectomy
for controlling vertigo.
Ablative procedures include labyrinthectomy
, vestibular nerve section, streptomycin perfusion of the labyrinth, and gentamicin or streptomycin instillation into the middle ear.
Four patients had previously undergone surgery (two vestibular neurectomies, one endolymphatic sac drainage, and one labyrinthectomy
) for incapacitating vertigo at other institutions.
Gentamicin relieves attacks of Meniere's disease in 80% of cases. If the vertigo attacks continue, the physician can perform either a posterior fossa vestibular neurectomy or a labyrinthectomy
, depending on the level of hearing.
In this study simultaneously labyrinthectomy
and cochlear implantation can be done in unilateral Meniere's disease which further assists in determining speech perception, localization and quality of life outcomes
when the vertigo becomes intractable, symptoms are disabling & patients had been unresponsive to medical therapy for at least 1 year, the disease may be treated by intratympanic gentamicin injection as a last resort prior to surgical labyrinthectomy
In some patients with medically refractory recurrent vertigo, ablative therapies that destroy labyrinthine function, such as intratympanic gentamicin, vestibular neurectomy, and surgical labyrinthectomy
, are effective at reducing episodes of vertigo, but with either sacrifice or risk to residual hearing and any remaining vestibular function in the treated ear.
The doctor may remove some of the bone around the inner ear (endolymphatic sac decompression), drain the inner ear fluid through a tube (endolymphatic shunt), cutting the nerve for balance (vestibular neurectomy) and the ultimate removing the inner ear (labyrinthectomy
Panula, "Plasticity of histamine H3 receptor expression and binding in the vestibular nuclei afer labyrinthectomy
in rat," BMC Neuroscience, vol.
In patients who have a complete unilateral vestibular loss secondary to vestibular neurectomy or labyrinthectomy
, the reported sensitivity and specificity of the HIT both reached the area of 100% when the ENG/VNG caloric test results were used as a reference.
In one study , done on monkeys subjected to a unilateral labyrinthectomy
, the authors explain that since "in everyday activity the animal moves its head in both directions and never repeatedly in one direction, there may be a conflict in the error signal induced by motion in the contralesional and ipsilesional directions.
[18,19] When intense attacks are frequent, more invasive procedures such as instillation of gentamicin or steroids via intratympanic injection or a grommet may be considered or, very rarely, vestibular nerve section or labyrinthectomy
. Surgery on the endolymphatic sac is of questionable value.