Cochlear Implantation in the Setting of Menière's Disease After Labyrinthectomy: A Meta-Analysis

Simultaneous Labyrinthectomy and Cochlear Implantation in Patients With Refractory Ménière's Disease

OBJECTIVE

To assess the efficacy and safety of simultaneous labyrinthectomy and cochlear implantation (CI) in patients with refractory Ménière's disease (MD).

METHODS

A retrospective review of patients with definite refractory MD per American Academy of Otolaryngology-Head and Neck Surgery treated via simultaneous transmastoid labyrinthectomy and CI was performed at a tertiary referral center. Patients' clinical and audiometric outcomes were assessed and analyzed.

RESULTS

Twenty-four patients underwent simultaneous transmastoid labyrinthectomy and CI between 7/2015 and 9/2023 (median age = 58 years [interquartile range (IQR) = 43.5-64.5], 54% female). Complete resolution of vertigo occurred in 23 patients (96%). Evaluating available data at ≥6 months postoperatively, both CNC (n = 9; 36% vs 40%, P = .76) and AzBio scores (n = 13; 40% vs 62%, P = .15) improved after surgery. When performing a sound localization task with the CI on, the median score in identifying the noise was 32% (IQR = 22%-56%) with a median degree error of 27.9 (IQR = 15.8-38.0) versus a median score with the CI off of 20% (IQR = 14%-42%) with a median degree error of 43.8 (IQR = 21.9-73.5) at a median of 9.8 months (IQR = 6.7-14.6) from surgery.

CONCLUSIONS

The present study represents one of the largest cohorts of refractory MD patients undergoing simultaneous labyrinthectomy and CI. Combining these procedures appears safe, enables excellent control of vertigo, and expedites aural rehabilitation in appropriately selected candidates, but future study is warranted to continue to evaluate this treatment paradigm.

Cochlear implant procedure. Italian Clinical Practice Guidelines of the Italian Society of Otorhinolaryngology (SIOeChCF) and Italian Society of Audiology and Phoniatrics (SIAF). Part 1: cochlear implants in adults

Objective

Cochlear implant (CI) is a well-established treatment for adults with sensorineural hearing loss and without benefit from hearing aids. The Italian guidelines date back 15 years; given the expansion of indications for CI, including single side deafness and asymmetrical hearing loss, it became necessary to establish updated guidelines.

Methods

Thirteen experts and 2 patient representatives selected the key questions and drew up recommendations. The document was developed following GRADE methodology. The methodological team of the Mario Negri Pharmacological Research Institute performed systematic reviews for each question and supported the overall process.

Results

Five key questions were identified and recommendations formulated, with subgroups and considerations on implementation.

Conclusions

Though the systematic research of scientific literature found a scarcity of randomised trials and an overall poor conduct and reporting quality of primary studies and systematic reviews, strong or conditional recommendations in favour of CI have been formulated for different subgroups of patients. Further studies should enrol a larger number of participants and use consistent instruments to evaluate hearing outcomes, in order to increase the comparability of results and data pooling with meta-analysis.

The Benefits of Cochlear Implantation for Adults: A Systematic Umbrella Review

OBJECTIVES

The uptake of cochlear implants among adults who could benefit (based on pure-tone audiometry) in developed countries is estimated to be less than 10%. Concerns about potential surgical complications, fear of losing residual hearing, and limited awareness about the benefits of this intervention contribute to the low adoption rate. To enhance quality of life and improve the uptake of cochlear implants, it is essential to have a clear understanding of their benefits.

DESIGN

This umbrella review aims to summarize the major benefits of cochlear implant usage in adults, by synthesizing findings from published review articles. A comprehensive search of databases including MEDLINE, EMBASE, PsycINFO, and Google Scholar, was conducted. The search was limited to English-language review articles published between 1990 and 2022, focusing on cochlear implant outcomes in at least 5 adults (aged ≥18 years). Two independent reviewers screened titles, abstracts, and full-text articles, and conducted a quality assessment using the Joanna Briggs Checklist for Systematic Reviews and Research Syntheses.

RESULTS

Forty-two articles were included in this review. There were 15 systematic reviews with meta-analysis, 25 systematic reviews without meta-analysis, and 2 systematic scoping reviews. All 42 articles underwent quality assessment using the Joanna Briggs Institute Checklist for Systematic Reviews and Research Syntheses, of which 40% (n = 17) satisfied 9 out of 11 quality criteria. This umbrella review shows that cochlear implants are associated with improvements in speech perception and recognition as well as improved quality of life and cognition. These benefits are observed in a significant proportion of adults undergoing the procedure, highlighting its effectiveness as a viable intervention for individuals with severe to profound hearing loss.

CONCLUSIONS

The potential benefits of cochlear implantation appear to outweigh the risks and complications associated with the procedure. It is recommended that adults with severe to profound hearing loss in particular, engage in informed discussions with healthcare professionals to consider cochlear implantation as a viable treatment option.

The role of cochlear implantation in alleviating Tumarkin drop attacks of Meniere's disease; a case report

Ménière's disease (MD) patients may suffer episodes of sudden falls, named Tumarkin drop attacks (DAs). This fall occurs abruptly and without warning or loss of consciousness. DAs usually aggravate the clinical picture of MD and are challenging to manage. The present report describes a case treated by cochlear implantation (CI) due to concomitant deafness and offers some clinical considerations for this condition. A male patient aged 48 years with a 10-year history of definite bilateral MD had profound SNHL on the right and severe SNHL on the left side. He suffered from intermittent attacks of vertigo, ear fullness, and tinnitus and, in the last year, had developed DAs and experienced 14 episodes in the previous six months. The preoperative category of acoustic performance was 3. The Dizziness Handicap Inventory (DHI) questionnaire showed a total score of 46, which indicated a moderate degree of disability. A CI was planned for the right side. The patient did not report any further DAs episode for two years since then. The postoperative category of acoustic performance became 11, and the postoperative DHI questionnaire showed a decrease in the total score (from 46 to 19), which indicated a mild disability. Unilateral CI effectively alleviated the DAs associated with bilateral MD. Our report proposes a new modality for managing vertiginous symptoms in cases of MD with hearing loss without the need for more aggressive surgical interventions with the need for clinical trials to confirm our results.

Mythbusters! The Truth about Common Misconceptions in Cochlear Implantation

Cochlear implantation (CI) is the preferred method of hearing rehabilitation when patients cannot perform well with traditional amplification. Unfortunately, there are still significant misconceptions around this life-changing intervention. The goal of this article is to address some of the most common myths around CI surgery. After reading this article, the learner will be able to explain the utility of CI in patients with residual hearing and recognize that insurance coverage is widespread. The reader will be able to list common risks associated with this well-tolerated procedure including anesthetic risk and the risk of vestibular dysfunction. Additionally, the reader will be able to identify the significant positive impact of CI on patients' quality of life. Finally, the reader will identify that many patients can safely have an MRI scan after implantation, including nearly all contemporary recipients.

The smaller the frequency-to-place mismatch the better the hearing outcomes in cochlear implant recipients?

OBJECTIVE

To investigate the effect of frequency-to-place mismatch, i.e. the mismatch between the tonotopic frequency map in the cochlea and the frequency band that is assigned to an electrode contact of a cochlear implant (CI) at the same cochlear location on speech perception outcomes, using postoperative CT images.

STUDY DESIGN

Retrospective observational single-centre study.

METHODS

Retrospective pre- and postoperative clinical CT data of 39 CI recipients with normal cochlear anatomy were analysed in an otological surgical planning software. The tonotopic frequency at each electrode position was estimated using the Greenwood function. For each patient, frequency-to-place mismatch between the tonotopic frequency and the fitted centre frequency for each electrode contact was calculated. The influence of frequency-to-place mismatch on speech perception in noise at 6 and 12 months after CI activation was studied.

RESULTS

A significant linear correlation was found between the frequency-to-place mismatch and speech perception in noise 6 months after cochlear implantation (p < 0.05). The smaller the frequency-to-place mismatch, the better the initial speech perception in noise results of the CI recipients. The significant effect disappeared after 12 months CI experience.

CONCLUSION

The study findings support the idea of minimizing the frequency-to-place mismatch in CI recipients in order to pursue better initial speech perception in noise. Further research is needed to investigate the prospect of tonotopic fitting strategies based upon postoperative CT images of the exact locations of the electrode contacts.