Browse the corpus

Labyrinthectomy is performed to treat intractable vertigo. It ablates the abnormal signals from a diseased vestibular system in order to facilitate central compensation. It can be performed via a transcanal or a transmastoid approach. This activity describes the indications, contraindications, and complications of labyrinthectomy and reviews the role of the interprofessional team in monitoring and managing the clinical sequelae of this surgery. Objectives: Identify the indications for performing a labyrinthectomy. Describe the equipment, personnel, preparation, and technique in regards to labyrinthectomy. Review appropriate evaluation of the potential complications and their clinical significance following labyrinthectomy. Summarize interprofessional team strategies for improving care coordination and communication to advance labyrinthectomy and improve outcomes. Access free multiple choice questions on this topic.

Labyrinthectomy is a surgical procedure of the temporal bone used to treat intractable and refractory vertigo. This procedure surgically removes the neuroepithelial elements of the semicircular canals and vestibule. Its goal is to ablate abnormal signals from a diseased vestibular system in order to facilitate central compensation, and it is generally very successful. The procedure does result in loss of all remaining hearing in the operated ear.

CSF Leak Typically caused by violating the macula cribrosa on the medial wall of the vestibule and allowing CSF penetration into the vestibule from the internal auditory canal. Facial Nerve Injury is possible as neuroepithelial elements of the vestibule, as well as the PSC, lie medial to the course of the facial nerve. Great care must be taken when dissecting these areas, and powered instrumentation should be avoided for this portion of the procedure. Disabling Chronic Disequilibrium is a rare unfortunate complication. Cochlear Ossification and the subsequent inability to rehabilitate hearing by cochlear implantation could be considered a less frequently acknowledged complication of labyrinthectomy. Cochlear patency is typically preserved for many years after labyrinthectomy.[12] Violation of the internal auditory canal and disruption of the labyrinthine artery may predispose to cochlear ossification.[13]

The otologic surgeon who would typically perform a labyrinthectomy likely works within a healthcare team to perform many other otologic procedures. If not, certainly, a working relationship needs to be established between the surgeon, the anesthesiologist, the circulating nurse, and the surgical technician. This will ensure proper preoperative preparations regarding antibiotic prophylaxis, steroid administration, and facial nerve monitoring concerns. This will also minimize delays resulting from a lack of proper supplies or equipment in the operating room.

Unlike with many other otologic procedures, a patient undergoing a labyrinthectomy is expected to be admitted as an inpatient after surgery. The admission typically revolves around control of the expected postoperative vertigo. Patients who experience a sudden ablation of vestibular function will experience severe vertigo along with nausea and possible vomiting for 48-72 hours after the procedure. During this time, the surgeon will need to work with skilled nursing to control symptoms with medication as well as to ensure proper hydration of the patient. During admission, a referral can be made to physical therapy to begin the process of vestibular rehabilitation and lower extremity conditioning.

After labyrinthectomy, the monitoring of the patient is typically shared between the otologist and the audiologist. Assuming that vertigo has been controlled, the degree of residual disequilibrium needs to be assessed and addressed. If vertigo recurs, vestibular testing with the audiologist will need to be repeated to determine if there is a remaining vestibular function in the operated ear or if the opposite ear has become diseased. The patient’s ability to adapt to the loss of hearing will need to be assessed. Hearing rehabilitation options will be discussed with the audiologist. This discussion will include options such as a CROS-type hearing aid, a bone-anchored hearing aid, and/or cochlear implantation.