A labyrinthectomy surgery is a specialised, destructive surgical procedure performed to treat and manage a condition known as vestibular dysfunction. If there is still very little hearing in the affected ear.
The goal of a labyrinthectomy procedure is to completely destroy the vestibular end organs to eliminate vestibular function. That is, stop the brain from receiving signals from the parts of the inner ear that sense motion and gravity changes. This relieves the symptoms connected with vertigo.
This is, however, used as a last resort option after it has been confirmed that a hearing aid will not be effective in helping to hear more clearly.
What necessitates labyrinthectomy surgery?
Labyrinthectomy surgery is usually considered for treatment of vestibular disorders, such as Meniere’s disease, after several treatment regimens have failed to yield positive responses. Hence, the following criteria are always considered for the labyrinthectomy procedure:
Conservative treatment for three to six months has failed more often.
There is severe loss of hearing in the affected ear
Experiencing severe disability associated with the disease.
What is the labyrinthectomy procedure?
There are two means to approach a labyrinthectomy procedure:
- The trans-canal labyrinthectomy procedure, and
- The trans-mastoid labyrinthectomy procedure.
The commonly performed labyrinthectomy procedure is the trans-canal labyrinthectomy procedure while the trans-mastoid labyrinthectomy procedure is typically used for patients who have narrow openings or canals.
Trans-canal labyrinthectomy procedure
For the trans-canal labyrinthectomy procedure, a tympanomeatal flap is created to enable access to the middle and inner ear to perform the curettage of the posterior annulus. This allows for the incus and the stapes to be removed by cutting the tendon of the stapedius muscle. The oval window is then drilled for enlargement in order to connect with the round window, before the end organ is then destroyed. Afterwards, the saccule and the utricle are then scraped and the semicircular canals are probed.
After complete destruction, an antibiotic-filled gelatin sponge is then used to fill up the vestibule.
The trans-canal labyrinthectomy procedure is less invasive, faster and has a very good outcome rate. However, there is a high chance of an incomplete removal of the neuro-epithelial tissue.
Trans-mastoid labyrinthectomy procedure
For the trans-mastoid labyrinthectomy procedure, an incision is made behind the ear to expose and cut off the mastoid bone to get visual of the structures of the middle and inner ear. This allows for the semicircular canals to be drilled and opened up. The facial nerve is, however, preserved. The semicircular canals drill gives access for vestibular end organs to be removed. After which, the cavity of the mastoid is then closed up.
The trans-mastoid labyrinthectomy procedure is considered to be the gold standard for labyrinthectomy surgery.it has an outcome rate of 95.5%.
Risk and complications of labyrinthectomy surgery.
Complications of labyrinthectomy surgery can be severe. Some of which include
Cerebrum Spinal Fluid Leakage: This is caused by a violation of the macula cribrosa on the medial wall of the vestibule. This violation give access for CSF penetration into the vestibule from the internal auditory canal.
Imbalance: there’s the probability of having difficulty in maintaining balance for about 4 to 6 weeks, or till the opposite ear is able to compensate.
Facial Nerve Injury: This is likely to occur as the neuroepithelial elements of the vestibule, as well as the PSC, lie medial to the course of the facial nerve. Therefore, great care must be exercised when dissecting these areas, and powered instrumentation must be avoided for this portion of the procedure.
Infection: there is likelihood of the incision site getting infected. This is characterised by pus formation, redness, warmth, swelling and tenderness.
Numbness: the ear operated upon may become numb and this may last for several months.
Cochlear Ossification: a less frequently acknowledged complication of labyrinthectomy is cochlear ossification, and subsequent inability to rehabilitate hearing by cochlear implantation.
Altered taste: taste sensation is likely to experience some changes such as constantly having a metallic taste. This may last for several months.
Other complications are
- Disabling chronic disequilibrium, which is a rare unfortunate complication of labyrinthectomy.
- A total loss of hearing in the ear operated upon.
- Vomiting or nausea.
- Moderate to severe headache may be experienced for a while.
- An incomplete procedure that did not eliminate symptoms.
What is the success rate of labyrinthectomy surgery?
An approximation of 95% of those who undergo a labyrinthectomy surgery experience relief after the surgery.
Recovery process from a labyrinthectomy surgery.
Aftermath of a labyrinthectomy surgery, a hospital stay is required for a few days for monitoring. You may be placed on medications for nausea and to prevent infection. Once you have regained enough balance and care for yourself, you will be discharged. There may be need for a cane or walker for support, and this can be either temporarily or permanently.
There may also be a need for a vestibular or balance therapy with a physical therapist to help you recover your balance more effectively.
What does a labyrinthectomy surgery aim at achieving?
The aim of a labyrinthectomy surgery is the complete destruction of all the vestibular end organs to eliminate all vestibular function. This in turn will relieve of all the symptoms associated with vertigo.
Can a labyrinthectomy surgery cure Meniere’s disease?
While a labyrinthectomy procedure may effectively alleviate all the symptoms associated with vertigo, it does not completely cure Meniere’s disease, as residue of neuronal activity may remain after the surgery.
Is the labyrinthectomy procedure painful?
Yes, it is. The labyrinthectomy procedure involves the removal of the neuroepithelial which consists of the sensory nerve cells that are very sensitive to pain.
Who should I consult for a labyrinthectomy surgery?
For a labyrinthectomy surgery, an Ear, Nose and Throat specialist doctor should be reached out to.