title: Cochlear implantation in patients with bilateral Ménière's syndrome.
abstract: OBJECTIVE
  To evaluate the indications and clinical outcomes (audiologic and vestibular) in patients with Ménière's syndrome who have undergone cochlear implantation.
  
  
  METHODS
  This is a retrospective review of patients at a large tertiary academic medical center.
  
  
  METHODS
  Nine patients were included in the study with AAO-HNS criteria for diagnosis of Ménière's syndrome as well as bilateral severe to profound sensorineural hearing loss as an indication for undergoing cochlear implantation. Audiologic criteria for implantation were considered in the context of speech recognition performance with well-fit, powerful hearing aids noting large fluctuations in performance levels in some patients. In all cases, the poorer hearing ear was implanted. Seven subjects had bilateral disease and had progressed to profound sensorineural hearing loss. The average age of the patients was 61 years. Six patients had undergone previous surgery to control vertigo, including endolymphatic shunt surgery and vestibular nerve section. No patient had received previous treatment with intra-tympanic gentamicin. Symptoms of Ménière's syndrome had been present in all patients for at least 10 years before implantation.
  
  
  METHODS
  Cochlear Implantation.
  
  
  METHODS
  Pre- and Postoperative audiometric scores (monosyllable words/phonemes, Central Institute for the Deaf (CID) sentences, Hearing in Noise Test (HINT) in quite/noise (+10 db)), pre- and postoperative vestibular symptoms (number of vestibular attacks, aural fullness, tinnitus).
  
  
  RESULTS
  Follow-up after implantation ranged from 1 to 5 years. Average 6 month postimplantation scores were: monosyllable words/phonemes = 52%/65%, CID sentences = 82%, HINT in quiet/noise = 70%/50%. Average 1-year postimplant scores were: monosyllable words/phonemes = 60%/76%, CID sentences = 97%, HINT in quiet/noise = 89%/78%. Postoperative speech recognition scores were, on average, substantially greater than preoperative scores. While there were few complications associated with implantation, some patients experienced alterations in their implant performance in association with fluctuations in vestibular symptoms.
  
  
  CONCLUSIONS
  Patients with advanced binaural involvement with Ménière's Disease may present a challenge to conventional criteria for cochlear implant candidacy because of fluctuating symptoms. We observed significant benefit over baseline in a consecutive series of patients with Ménière's syndrome who progressed to bilateral, severe-to-profound sensorineural hearing loss and underwent cochlear implantation. Further, previous vestibular surgery, including labyrinthectomy, does not contraindicate cochlear implantation.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA. llustig@jhmi.edu
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Lustig
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yeagle
authors.forename: John K
authors.initials: JK
authors.lastname: Niparko
authors.forename: Lloyd B
authors.initials: LB
authors.lastname: Minor
mesh_terms: D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D019929:Cochlear Implantation; D007758:Ear, Inner / Q000601:surgery; D018159:Endolymphatic Hydrops / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006312:Hearing Loss, Bilateral / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013063:Speech Discrimination Tests; D013067:Speech Perception / Q000502:physiology