Labyrinthectomy - Indications, Contraindications, and Types

What Is Labyrinthectomy?

Labyrinthectomy is the surgical procedure to remove the inner ear's labyrinth, consisting of the vestibule, semicircular canals, and cochlea. The treatment of vertigo is achieved at the expense of hearing; hence the procedure is done for patients with compromised hearing on the affected side. It is a procedure done to treat Meniere's disease. Labyrinthectomy was developed many years back to treat intractable vertigo and remains the best option to destroy the vestibular function in an affected ear.

Labrythincteomy involves completely removing the organ responsible for balance and other soft tissues of the vestibule. So, the signals from the regions of the inner ear which sense the change in motion and gravity are not sent to the brain. Since removing the cochlea will result in complete hearing loss, the procedure is advised only for patients with non-serviceable hearing in the operated ear. Therefore, this procedure is infrequently done to preserve hearing during the treatment has become the norm. However, this procedure remains the gold standard for treating disabling episodic vertigo in unilateral Meniere's disease patients and other intractable vertigo cases.

What Is the Anatomy and Physiology of the Inner Ear?

The inner ear consists of a bony labyrinth. The labyrinth has five organs: the superior, lateral, and posterior semicircular canals (SSC, LSC, and PSC, respectively), the utricle, and the saccule. The semicircular canal and the vestibule are responsible for balance, whereas the cochlea is responsible for hearing. The lining of the vestibular system contains the sensory receptors responsible for maintaining balance by sensing changes in linear motion, rotation, and gravity. Any damage to these structures from injury or diseases can result in loss of balance, giving rise to vertigo.

What Are the Indications for Labyrinthectomy?

Labyrinthectomy is advised for patients with the following:

• Patients with poor or non-serviceable hearing.

• Older patients who are above 60 years of age.

• Patients in whom intracranial procedures are not indicated.

• Patients in whom other conservative treatment methods have failed.

• Patients in whom hearing-sparing surgeries were failures.

• The patients with Meniere’s disease have affected their day-to-day living.

What Are the Contraindications for Labyrinthectomy?

Labyrinthectomy causes hearing loss in the operated ear. Labyrinthectomy is contraindicated in people whose affected ear is the only hearing ear, as the person will have complete hearing loss after the procedure. However, chemical labyrinthectomy or vestibular nerve sectioning should be considered in patients with normal hearing.

What Are the Types of Labyrinthectomy?

There are two main types of labyrinthectomy, and they are trans-canal and trans-mastoid. Apart from these two, there is another technique called chemical labyrinthectomy, which is not similar to the conventional labyrinthectomy as it does not involve surgery.

• Trans-Canal Labyrinthectomy - In this technique, the vestibule is approached through an incision in the tympanic membrane or the eardrum, removing the stapes bone and drilling through the bone adjacent to the vestibule. The neuroepithelium is then removed by using a hook and suction. They have many advantages as it is less invasive than trans-mastoid labyrinthectomy. They have a shorter duration and lower morbidity than the trans-mastoid approach.

• Trans-Mastoid Labyrinthectomy - The semicircular canals and vestibules are opened in this procedure, and the neuroepithelium is cut under direct visualization.

• Chemical Labyrinthectomy - In this technique, the antibiotic gentamicin is infused into the middle ear and absorbed through the round window, which is the opening between the middle and the inner ear into the vestibule. The antibiotic prevents the impulses from being passed into the brain by destroying the vestibular hair cells.

What Are the Risks Associated With Labyrinthectomy?

The risks associated with a labyrinthectomy can be severe, and they are:

• CSF (cerebrospinal fluid) leakage. The CSF may penetrate the vestibule from the internal auditory canal.

• Complete hearing loss in the affected ear.

• Facial nerve injury can happen during the dissection and instrumentation during the procedure.

• Loss of balance function in the affected ear.

• Nausea and vomiting.

• An incomplete procedure that does not eliminate the symptoms.

• Cochlear ossification can happen and will prevent rehabilitation by cochlear implantation.

What to Expect During a Labyrinthectomy?

A labyrinthectomy is done in a hospital under general anesthesia. The doctor will perform using either the trans-canal or the trans-mastoid approach. The trans-canal approach is used in most patients, and the trans-mastoid approach is done in patients with narrow canals or openings. The vestibular end organs are removed in both procedures.

What to Expect After Surgery?

Spend two to three days in the hospital after the surgery. After the surgery, one can expect an incision behind or above the ear and a dressing over the ear and head.

The common side effects after the surgery include:

• Headache.

• Numbness around the incision, which might last for months.

• Surgery corrects vertigo attacks, but there can still be trouble balancing for 4 to 6 weeks after surgery while the other ear learns to compensate for the loss of balance. A physical therapist can help to deal with the symptoms.

• The hearing in the ear following the surgery will be compromised.

• One can have an altered taste for a few months.

How to Recover From Labyrinthectomy?

After the labyrinthectomy, the patient will be monitored in the hospital for a few days. Then, the doctors will prescribe medicine to prevent infections and nausea. Finally, they will be discharged from the hospital when the doctor determines that the person has regained enough balance to care for themselves at home. Sometimes, the patients might need a cane or walker, either temporarily or permanently.

Also, some patients may need vestibular or balance therapy with a physical therapist to recover their balance more effectively.

Conclusion

Labyrinthectomy is a procedure to correct patients with vertigo affecting their daily living. This procedure is advised for patients with hearing loss associated with vertigo; otherwise, the hearing will also be compromised as this procedure will result in hearing loss. If someone has vertigo, consult the specialist to know all the treatment options available and what is best for them.