Transcanal labyrinthectomy for intractable vertigo after unilateral cochlear implantation.

Objective: Document the use of transcanal labyrinthectomy to treat disabling attacks of vertigo after unilateral cochlear implantation.

Patient: A 46-year-old woman with severe-profound bilateral sensorineural hearing loss secondary to enlarged vestibular aqueducts underwent cochlear implantation for her right ear with a Nucleus Freedom device. The surgery was uneventful, and postoperative imaging confirmed that the electrode was positioned properly. She developed episodic vertigo 10 to 14 days after the implant surgery, which failed to improve with aggressive vestibular rehabilitation therapy. Plugging of the round window for possible perilymphatic fistula did not relieve her symptoms.

Intervention: Right transcanal labyrinthectomy supplemented by filling the vestibule with gentamicin-soaked Gelfoam and then a customized vestibular rehabilitation program.

Main Outcome Measure: Comparison of vestibular symptoms and cochlear implant performance before and after transcanal labyrinthectomy.

Results: The patient had immediate relief of symptoms, and the function of the cochlear implant was not adversely affected.

Conclusion: Transcanal labyrinthectomy may be an effective method to ablate the vestibular end organ after unilateral cochlear implantation. It can offer relief of disabling vertigo without adversely affecting the performance of the implant.