Transmastoid labyrinthectomy versus translabyrinthine vestibular nerve section: does cutting the vestibular nerve make a difference in outcome?

Antonio De La Cruz, Karen Borne Teufert, Karen I Berliner
Otology & Neurotology 2007, 28 (6): 801-8

OBJECTIVE: Analyze differences in outcomes between labyrinthectomy with and without vestibular nerve section, including characteristics of symptoms and time course for improvement.

STUDY DESIGN: Patient survey.

SETTING: Tertiary referral neurotologic private practice.

PATIENTS/INTERVENTION: Twenty-five patients who underwent transmastoid labyrinthectomies and 17 who underwent translabyrinthine vestibular nerve section (TLVNS). Patients with a diagnosis of Meniere's disease comprised 64.0 and 64.7% of the two groups, respectively.

MAIN OUTCOME MEASURES: A mail questionnaire assessed frequency, severity, interference, and disability for both vertigo ("spinning dizziness") and dysequilibrium ("imbalance/unsteadiness") before and after surgery as well as the time course of improvements.

RESULTS: Approximately 24% of each group still has vertigo (spinning dizziness). On average, both groups indicated resolution of vertigo at 2 to 3 weeks on average (longer for imbalance). There were no significant differences between groups in vertigo characteristics, but TLVNS did show advantages in imbalance outcomes. American Academy of Otolaryngology-Head and Neck Surgery functional disability showed improvement in 73 and 52% of the TLVNS and labyrinthectomy groups, respectively. The TLVNS group was more likely to have improved imbalance (81.3 versus 45.8%, p <or= 0.047) and tended more frequently to rate it as currently not severe/none (76.5 versus 45.8%, p <or= 0.06). The labyrinthectomy group did not show significant improvement in any imbalance characteristics, whereas the TLVNS group improved in all characteristics. When limited to patients with Meniere's disease, results are similar, but differences between groups are smaller, and improvement in imbalance did also occur for the labyrinthectomy group.

CONCLUSION: Both transmastoid labyrinthectomy and TLVNS provide good control of vertigo (>85% Class A or B). However, patients undergoing TLVNS were more likely to show improvement in imbalance and functional disability. This difference was less pronounced in patients with Meniere's disease.

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