Surgery For Vertigo Research Articles

Surgery for vertigo: 10-year audit from a contemporary vertigo clinic.

To present the profile of patients undergoing surgical treatment for vertigo at a contemporary institutional vertigo clinic. A retrospective analysis of clinical charts. The charts of 1060 patients, referred to an institutional vertigo clinic from January 2003 to December 2012, were studied. The clinical profile and long-term outcomes of patients who underwent surgery were analysed. Of 1060 patients, 12 (1.13 per cent) were managed surgically. Of these, disease-modifying surgical procedures included perilymphatic fistula repair (n = 7) and microvascular decompression of the vestibular nerve (n = 1). Labyrinth destructive procedures included transmastoid labyrinthectomy (n = 2) and labyrinthectomy with vestibular nerve section (n = 1). One patient with vestibular schwannoma underwent both a disease-modifying and destructive procedure (translabyrinthine excision). All patients achieved excellent vertigo control, classified as per the American Academy of Otolaryngology - Head and Neck Surgery 1995 criteria. With the advent of intratympanic treatments, surgical treatments for vertigo have become further limited. However, surgery with directed intent, in select patients, can give excellent results.

Chirurgie des vertiges

Spontaneous recovery or central compensation makes surgical procedures rare in patients with vertigo. Surgery for vertigo proposed after pharmacological or physical therapy fails to eliminate Ménière's disease and some very rare cases of paroxystic positional vertigo. The main target in treating Ménière's disease is to promote vestibular compensation, which is possible only with a nonprogressive and stable deficit leading to readjustment of vestibular reflexes. Surgical procedures can be classified as nondestructive (endolymphatic sac decompression, vestibular nerve decompression, patching of perilymphatic fistulas), selectively destructive (middle fossa or retrosigmoid vestibular neurotomy, lateral semi-circular plugging) and destructive (labyrinthectomy). Surgical indications essentially concern incapacitating vertigo and depend mainly on hearing status. In Ménière's disease, vestibular neurotomy can be regarded as the gold standard considering its good results on vertiginous episodes; however, scoring with functional and quality-of-life scales bring out residual deficiency in some cases.

Persistent Dizziness After Surgical Treatment of Vertigo

Persistent vertigo and imbalance can occur after surgery for vertigo regardless of surgical approach. This study explored for factors affecting outcome of vertigo surgery. Patient survey and chart review. Tertiary referral neurotologic private practice. Of 111 patients (57.7% female; mean age, 52.3 yr), 59 underwent vestibular nerve section (middle fossa, retrolabyrinthine, and translabyrinthine), 25 underwent transmastoid labyrinthectomy, and 27 underwent endolymphatic sac shunt. Eighty-three percent had Ménière's disease. Mean follow-up was 4.3 years. Primary outcomes included American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) vertigo score and class, number of spells per month, current and change in AAO-HNS disability rating, vertigo and imbalance severity ratings, and frequency of imbalance. Three preoperative factors were consistently related to outcome: AAO-HNS disability rating, imbalance frequency rating, and duration of first symptom ([rho] = 0.19-0.51; all p's < 0.05). Greater disability and more frequent imbalance related to poorer outcome, but longer duration of disease related to better outcome. Presurgery vertigo characteristics were generally not related to outcome. Ménière's patients were more likely to have improvement in imbalance, as were those with no other significant disease and no allergy. The presence of tinnitus in the contralateral ear was associated with poorer outcomes, including a lower rate of results of Classes A and B (p = 0.023). Vertigo as a first symptom and the presence of eye disease also showed relationships to poorer outcome. Those rating themselves as more disabled before surgery are less likely to achieve the best outcomes, whereas frequency and severity of preoperative vertigo are not predictive. Several possible prognostic factors were identified that warrant future prospective study.

Complications of surgery for vertigo

Surgery for the treatment of vertigo carries significant risk for complications, as do all surgical procedures. Some of the risks are inherent to any mastoid surgery, including facial paralysis and hearing loss. Procedure-specific complications, such as sequelae inherent to the intracranial procedures, are rare. Proper attention to surgical technique will minimize, but cannot eliminate, the risks of surgery. The majority of patients who undergo surgery to relieve vertigo greatly benefit from the surgery and would undergo the procedure again.

Schwannoma in the vestibule and cochlea

Schwannoma of the vestibule or the cochlea is an unusual lesion. In the past, most examples have been found at autopsy or as unsuspected findings at surgery for vertigo. The symptoms of isolated labyrinthine schwannoma may be indistinguishable from advanced Meniere's disease. Magnetic resonance imaging has led to pre-operative diagnosis in some cases. Two cases of schwannoma within the labyrinth from a series of 339 symptomatic acoustic tumours, are presented and the imaging findings are discussed.

Sensorineural hearing loss with delayed onset of vertigo

Sensorineural hearing loss with delayed onset of vertigo is a syndrome in which episodic vertigo arises in a person who has preexisting unilateral severe-to-profound sensorineural hearing loss. This syndrome has an ipsilateral form in which the vertigo arises from the poorer hearing ear and a contralateral form in which the aural symptoms arise from the better hearing ear. The existence of this syndrome has only been noted within the past two decades. This report details our clinical experience with 17 persons with the ipsilateral form of this disorder. The onset of the vertigo after the occurrence of the hearing loss was quite variable. It ranged from 1 to 60 years after the development of the hearing loss. The hearing loss occurred for several reasons. Most patients had hearing loss due to an unknown cause. The development of the vertigo and the timing of the onset of the vertigo were not related to the cause of the hearing loss. Bithermal caloric testing identified the offending labyrinth in most patients who underwent ablative vestibular surgery. Ablative vestibular surgery was performed in 13 of the 17 persons in this study because of disabling symptoms. In all 13 cases, the episodic vertigo was eliminated. Surgical treatment for sensorineural hearing loss with delayed-onset vertigo, as with all surgery for vertigo, should be based on the severity of the afflicted person's symptoms. (OTOLARYNGOL HEAD NECK SURG 1995;112:540-3.)

Sensorineural hearing loss with delayed onset of vertigo.

Sensorineural hearing loss with delayed onset of vertigo is a syndrome in which episodic vertigo arises in a person who has preexisting unilateral severe-to-profound sensorineural hearing loss. This syndrome has an ipsilateral form in which the vertigo arises from the poorer hearing ear and a contralateral form in which the aural symptoms arise from the better hearing ear. The existence of this syndrome has only been noted within the past two decades. This report details our clinical experience with 17 persons with the ipsilateral form of this disorder. The onset of the vertigo after the occurrence of the hearing loss was quite variable. It ranged from 1 to 60 years after the development of the hearing loss. The hearing loss occurred for several reasons. Most patients had hearing loss due to an unknown cause. The development of the vertigo and the timing of the onset of the vertigo were not related to the cause of the hearing loss. Bithermal caloric testing identified the offending labyrinth in most patients who underwent ablative vestibular surgery. Ablative vestibular surgery was performed in 13 of the 17 persons in this study because of disabling symptoms. In all 13 cases, the episodic vertigo was eliminated. Surgical treatment for sensorineural hearing loss with delayed-onset vertigo, as with all surgery for vertigo, should be based on the severity of the afflicted person's symptoms.

Surgery for non-Menière's vertigo.

Neurootologists are fortunate in having a considerable number of surgical options available to them for the treatment of patients with disabling vertigo. Most surgery for vertigo is performed on patients suffering from the ravages of Meniere's disease. In addition, other forms of disabling peripheral vertigo may also be surgically managed. Over a 3 year period, the author performed surgery on 14 patients suffering from disabling non-Meniere's vertigo. During the same period, 60 patients with Meniere's disease underwent surgical treatment. There were three non-Meniere's conditions for which surgery was performed: chronic vestibular neuronitis, delayed onset vertigo (after sensorineural hearing loss), and labyrinthine injury following temporal bone fracture. Two surgical operations were utilized: transmastoid labyrinthectomy and selective vestibular neurectomy. At 1 year follow-up all of the patients involved in this study enjoyed either total relief of symptoms or marked improvement, demonstrating that satisfactory surgical results can be obtained for non-Meniere's vertigo. However, surgeons must exercise extreme caution in selecting non-Meniere's patients for surgery. Moreover, proper patient selection, accurate diagnosis and the exclusion of central disease are crucial in obtaining good surgical results.

The effect of endolymphatic system surgery on tinnitus in Menière's disease and hydrops

AbstractOne hundred and seventy-two patients with Menière's disease (including tinnitus) who underwent endolymphatic system (ELS) surgery for vertigo and/or hearing loss, were evaluated to determine whether ELS surgery had an incidental effect on tinnitus. Tinnitus was eliminated in 34 patients (19.9 per cent), reduced in 64 patients (37.2 per cent), unchanged in 39 patients (22.6 per cent), and worse in 35 patients (20.3 per cent). No significant correlation existed between surgical results for hearing and an improvement in tinnitus. A successful elimination of vertigo, however, was associated with better results for tinnitus relief. Tinnitus is not considered to be an indication for ELS surgery.

Surgery for vertigo.

Surgery for vertigo.