Simultaneous Labyrinthectomy and Cochlear Implantation
30 September 2019 (online)
Introduction Reports indicate that the cochlea remains responsive to electrical stimulation following labyrinthectomy. Post-stapedotomy surgery complications like persistent vertigo and sensorineural hearing loss are debilitating. This case describes the management of a patient by simultaneous labyrinthectomy and cochlear implantation following complications of stapedotomy.
Case Presentation A 37-year-old male teacher who had undergone stapedotomy 1 month ago at a local hospital, presented with complaints of right ear hearing loss and vertigo. Examination revealed a right-sided posterior marginal perforation and dislocated stapes piston with clear fluid seen filling the middle ear. Pure tone audiogram showed a right ear moderate to severe mixed hearing loss and a left moderate mixed hearing loss. A high-resolution computerized tomogram (HRCT) of the temporal bone was normal. Right revision stapedotomy, closure of perilymph leak and myringoplasty were done. Patient improved symptomatically with improvement of hearing and relief from vertigo. However, 3 months later patient developed viral labyrinthitis with severe vertigo and right-sided severe profound hearing loss. He was treated conservatively with IV antibiotics. Patient continued to have intractable vertigo and hearing loss. The patient subsequently underwent right simultaneous labyrinthectomy and cochlear implantation 7 months after the second surgery. Postoperatively, the patient had dramatic relief from vertigo and was able to resume to his daily routine activities.
Discussion and Conclusion Simultaneous labyrinthectomy and cochlear implantation following complications of stapedotomy offers successful treatment and is yet another indication for cochlear implantation.