Labyrinthectomy is a surgical procedure performed to remove the neuroepithelial elements of the semicircular canals and vestibule.
Some facts about Labyrinthectomy:
- Temporal bone are used to treat intractable and refractory vertigo.
- Poorly compensated unilateral peripheral vestibular dysfunction can be managed in the presence of a nonserviceable hearing ear.
- All the semicircular canals and vestibules are symmetrically opened and the landmarks should be preserved until the end of labyrinthectomy.
- The vestibular end organs are completely destroyed to eliminate vestibular function in Labyrinthectomy.
- Complications associated with a labyrinthectomy can be severe and include Cerebrospinal fluid (CSF) leak, complete loss of hearing on the affected ear, facial nerve injury, loss of balance function in affected ear, vomiting or nausea and incomplete procedure that does not eliminate symptoms.
- Labyrinthectomy is considered for the treatment of vestibular disorders when adequate medical therapy and rehabilitation have failed to address the condition.
- Anti-emetic medications can be given to the patient postoperatively to minimize vomiting and nausea, which may be present for several days.
- Informed consent is very important for this procedure as hearing loss on the side operated on is inevitable.
Procedure for Labyrinthectomy:
- Generally, a labyrinthectomy is performed in a hospital under general anesthesia.
- The procedure may be done using the transcanal approach or the transmastoid approach.
- The transmastoid approach is used for patients who have narrow canals or openings, while the transcanal approach is preferred for most patients.
- The vestibular end organs are removed in both approach.
- A tympanomeatal flap will be created to gain access to the middle and inner ear to perform the curettage of the posterior annulus in the transcanal approach.
- The incus and the stapes will be removed by cutting the tendon of the stapedius muscle.
- The oval window is made larger by drilling it, in order to connect with the round window before the end organ is destroyed.
- The saccule and the utricle are then scraped and the semicircular canals are probed.
- An antibiotic-filled gelatin sponge may be used to fill up the vestibule once the destruction is completed.
- An incision behind the ear will be made to expose and cut the mastoid bone and to visualize the structures of the middle and inner ear in the transmastoid approach.
- The semicircular canals will be drilled and opened up, and the facial nerve will be preserved.
- The vestibular end organs will be removed and the cavity of the mastoid will be closed.
- A facial nerve monitor will be used by the surgeon during the procedure, to make sure that the nerve is preserved.
- Cerebrospinal fluid (CSF) leak needs to be repaired at the same time if the leak is noted during the operation.
- A muscle plug may have to be placed for bigger leaks.
- It is important to repair CSF leaks as they may cause serious complications, such as meningitis.
- You will need to be monitored in the hospital for a few days after a labyrinthectomy.
- Medications for nausea and to prevent infection will be prescribed by your doctor.
- You may need vestibular or balance therapy by a physical therapist in order to more effectively recover your balance.
