Prior Surgery No Barrier to Cochlear Implantation for Ménière's Disease
Key findings
- This study evaluated the outcomes of adults who received unilateral (n=6) or bilateral (n=23) cochlear implants because of deafness caused by Ménière's disease
- On average, postoperative monosyllabic word recognition scores were significantly higher than preoperative scores, improved significantly over time, and were not affected by the duration of hearing loss before cochlear implantation
- Cochlear implants improved monosyllabic word scores regardless of whether patients had received prior medical treatment, endolymphatic sac surgery, or labyrinthectomy
- In patients who received bilateral implants sequentially, no significant postoperative differences were noted between the monoaural word scores of both ears or between the monaural and binaural word scores
- After age 70, improvement in word recognition declined steeply as a function of age at implantation, although mean word recognition scores increased significantly in adults ≥70 as well as in younger adults
A cochlear implant (CI) is currently the only treatment available for patients with profound hearing loss due to Ménière's disease. By reviewing two decades of patient data, researchers at Mass Eye and Ear have determined CIs can benefit this population regardless of previous surgical treatment or age at implantation.
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Steven D. Rauch, MD, director of the Vestibular Division at Mass Eye and Ear, and colleagues report the data in Otolaryngology-Head and Neck Surgery.
Methods
29 adults (34 ears) were postlingually deafened by Ménière's disease and received a CI at Mass Eye and Ear between 1996 and 2016:
- 18 patients with bilateral end-stage Ménière's disease who received a single CI
- 5 patients with bilateral end-stage Ménière's disease who received two CIs sequentially
- 6 patients with unilateral Ménière's disease and contralateral hearing loss of different etiology; received a CI in the Ménière's ear
The mean age at implantation was 65, and the mean postoperative follow-up was 5.7 years.
Overall Outcomes
The mean monosyllabic word recognition score was:
- Preoperatively—9.5%
- 1 month postoperatively—37% (P<.00001 vs. preoperative)
- 3 months—46% (P=0.003 vs. 1 month)
- 6 months—54% (P=0.0018 vs. 3 months)
- 1 year—59%
- >1 year—67% (P=0.0199 vs. 1 year)
The overall mean difference between pre- and postoperative speech recognition after >1 year was 56%. Duration of hearing loss duration was not correlated with the score at >1 year.
Effect of Previous Ménière's Treatment
CIs improved word recognition scores regardless of whether patients had received prior medical treatment, endolymphatic sac surgery, or labyrinthectomy. Previous Ménière's surgery should not be considered a contraindication for cochlear implantation.
Effect of Age at Implantation
Thirteen of the 34 CIs (38%) were implanted in patients ≥70 years old. Preoperatively, there was no significant difference in mean word scores between this group and adults under 70.
At >1 year, mean scores were higher in the younger group (76% vs. 50% of patients ≥70; P=0.0013). However, mean word scores increased significantly in both age groups.
After age 70, CI benefits declined steeply as a function of greater age at implantation.
Effect of Bilateral Implants
In the patients who received bilateral implants sequentially, no significant postoperative differences were noted between the monoaural word scores of both ears or between the monaural and binaural word scores.
OTO Podcast, an American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation journal podcast, featured Dr. Rauch's research on Meniere's disease in its March 2022 episode. Listen here.
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Learn more about the Department of Otolaryngology–Head and Neck Surgery at Mass Eye and Ear
Refer a patient to Mass Eye and Ear/Mass General Brigham