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Original Investigation |

Cochlear Implantation in Ménière’s Disease

Tim A. Fife, MD1; Meagan P. Lewis, AuD1; John S. May, MD1; Eric R. Oliver, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
JAMA Otolaryngol Head Neck Surg. 2014;140(6):535-539. doi:10.1001/jamaoto.2014.550.
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Importance  Though the effects of cochlear implantation (CI) on patients with hearing loss has been well described, its effect on the auditory and vestibular symptoms in patients with Ménière’s disease (MD) has not been firmly established.

Objectives  To determine whether CI in patients with MD improves hearing performance as measured by standard post-CI audiometric testing and to describe the impact of CI on subjective auditory and vestibular quality-of-life measures.

Design, Setting, and Participants  Retrospective review of all patients with MD 18 years or older who met diagnostic criteria for definite MD and underwent CI at Wake Forest University Baptist Medical Center, a tertiary care academic medical center, from 2000 through 2012.

Interventions  Patients were invited to answer questions regarding their current hearing ability, subjective perception of symptoms, and functional status related to their MD before and after CI. Patient records were reviewed for pertinent information. Results were then analyzed for statistical significance.

Main Outcomes and Measures  Pre-CI and post-CI sentence testing scores, frequency and severity of MD vestibular and auditory symptoms via the MD Functional Level Scale (FLS), and hearing quality of life via the Hearing Handicap Index were reviewed.

Results  Eleven CIs were performed in 10 patients. Mean long-term follow-up was 41 months. The mean age at first implantation was 64 years. The mean sentence testing scores in quiet improved from 22.8% before CI to 77.0% after CI (P < .001) at the most recent follow-up. Mean (SD) pre-CI and post-CI MD-FLS vestibular scores were similar: 3.9 (1.9) and 3.4 (1.9) (P = .52).

Conclusions and Relevance  Patients with MD who undergo CI are capable of achieving substantial receptive communication improvement comparable to the gains experienced by patients without MD. Implantation seems to neither adversely alter the natural history of vestibular function nor notable exacerbate auditory symptoms.

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Figure.
Sentence Recognition Testing and MD-FLS Score Before and After CI

A, Sentence recognition testing in quiet (at most recent follow-up). All sentence testing was performed in best-aided conditions both before and after cochlear Implantation (CI). The percentages listed on the y-axis represent the percent correct on AzBio and Hearing in Noise Test (HINT) sentence testing. The difference between the 2 groups was significant (P < .001). B, The Ménière’s Disease Functional Level Scale (MD-FLS) is a patient-administered 6-point scaling system that determines degree of functionality related to vestibular symptoms of Ménière’s disease. Data from 10 patients are included. The difference between the 2 groups, recorded at the most recent follow-up, was not significant (P = .52).

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