Objective: To evaluate the feasibility of combining simultaneous triple semicircular canal plugging (TSCP) and cochlear implantation (CI) to treat vertigo and hearing loss in advanced Meniere's disease(MD) patients, so as to provide an alternative surgical procedure for treating this disorder. Methods: Data from seven patients, who were referred to our hospital and diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006), from Jan. 2015 to Jan. 2016, were retrospectively analyzed in this work. Seven patients, in whom the standardized conservative treatment had been given for at least one year and frequent vertigo still occurred, underwent simultaneous TSCP and CI under general anesthesia via mastoid approach. Postoperative follow-up time was more than six months. Vertigo control and auditory function were measured. Pure tone audiometry, speech perception scores, caloric test, head impulse test (HIT), and vestibular evoked myogenic potential (VEMP) were performed for evaluation of audiological and vestibular functions. Results: All patients had bilateral severe sensorineural hearing loss preoperatively. One side hearing loss was due to MD and another side was due to reasons including sudden sensorineural hearing loss, mumps and other unknown reason. The total control rate of vertigo in seven MD patients was 100.0% in the six-month follow-up, with complete control rate of 85.7% (6/7) and substantial control rate of 14.3% (1/7). Improved hearing threshold and speech perception scores were observed in all study participants. Postoperative average aided hearing threshold was 32.5 dBHL, the average monosyllabic word score was 42.6% and speech perception scores of sentences tested in quiet was 52.3%. Tinnitus improved in five cases, and no significant change in two patients. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3-5 days, while, an average recovery time of balance disorders was 19.7 days. Six months after treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in cVEMP or oVEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid leakage, and other complications. Conclusions: A combined approach of TSCP and CI which could control vertigo effectively and improve hearing loss and tinnitus represents an effective and safe therapy for some advanced MD patients.
目的： 观察晚期梅尼埃病患者半规管阻塞联合人工耳蜗植入手术的临床疗效，评价该方法用于治疗晚期梅尼埃病患者眩晕、耳聋及耳鸣的有效性和安全性。 方法： 分析山东大学附属省立医院耳鼻咽喉头颈外科2015年1月至2016年1月7例行半规管阻塞联合人工耳蜗植入手术的梅尼埃病患者的临床资料。7例患者均确诊为单侧梅尼埃病，术前均为双侧重度感音神经性聋，另一侧听力为非梅尼埃病的其他原因(突发性聋、腮腺炎及不明原因等)引起的重度感音神经性聋，所有患者均经规范化药物保守治疗至少1年以上，但眩晕仍反复发作。手术为全麻下经乳突进路行三个半规管阻塞联合人工耳蜗植入，术后随访半年以上。观察指标主要包括眩晕控制、听力改善及耳鸣改善三个方面，分别于术前及术后半年时行纯音测听、人工耳蜗助听听阈、言语识别率、前庭双温试验、前庭诱发肌源性电位(VEMP)、视频头脉冲试验等检查，评价其听觉和前庭功能。 结果： 7例患者术后均无面神经麻痹、脑脊液漏等并发症发生，眩晕均得到有效控制，其中眩晕控制A级6例，眩晕控制B级1例；7例患者手术耳听力均得到改善，手术侧人工耳蜗平均助听听阈为32.5 dBHL，平均言语识别率扬扬格词42.6%、安静下句子52.3%；耳鸣改善5例，无明显变化2例。所有患者术后均出现短时间眩晕及平衡障碍，其中眩晕在术后3～5 d内消失，平衡功能恢复时间平均19.7 d。术后半年复查，所有患者前庭双温试验示术侧半规管功能丧失， VEMP检查示耳石器功能无明显变化。 结论： 半规管阻塞术联合人工耳蜗植入既能有效控制眩晕发作，又能恢复患侧听力及改善耳鸣，是治疗晚期梅尼埃病安全有效的方法。.
Keywords: Cochlear implantation; Hearing loss, sensorineural; Meniere disease; Otologic surgical procedures; Semicircular canals.