Transmastoid labyrinthectomy versus translabyrinthine vestibular nerve section: does cutting the vestibular nerve make a difference in outcome?
OBJECTIVE
Analyze differences in outcomes between labyrinthectomy with and without vestibular nerve section, including characteristics of symptoms and time course for improvement.


METHODS
Patient survey.


METHODS
Tertiary referral neurotologic private practice.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
De La Cruz
Antonio
A
House Ear Institute, Los Angeles, California 90057, USA. adelacruz@hei.org
Borne Teufert
Karen
K
Berliner
Karen I
KI
D000368:Aged; D003627:Data Interpretation, Statistical; D003714:Denervation; D007758:Ear, Inner / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008575:Meniere Disease / Q000601:surgery; D008875:Middle Aged; D013506:Otologic Surgical Procedures; D004856:Postural Balance / Q000502:physiology; D013199:Stapes / Q000473:pathology; D016896:Treatment Outcome; D014717:Vertigo / Q000601:surgery*; D014724:Vestibular Function Tests; D014725:Vestibular Nerve / Q000601:surgery*