Shashidhar Kusuma1, Steve Liou, David S Haynes. 1. Vanderbilt Bill Wilkerson Center for the Hearing and Communication Sciences, Division of Otology/Neurotology, Nashville, TN 37205, USA.
Abstract
OBJECTIVES: Cochlear implantation has become a safe and effective method for the auditory rehabilitation of the profoundly hearing impaired. Incidence of disequilibrium and vertigo after cochlear implantation ranges from 13% to 74% in the literature. Most patients report resolution of these symptoms with medical therapy and vestibular rehabilitation. We present a case of persistent disequilibrium after cochlear implantation. Further workup of this patient revealed radiographic findings suggestive of a perilymphatic fistula, with immediate and complete resolution of symptoms after exploratory tympanotomy and packing around the cochleostomy. STUDY DESIGN: Case report. METHODS: A retrospective chart review of a patient with postoperative disequilibrium unresponsive to maximal medical and vestibular rehabilitation therapy. RESULTS: Diagnostic workup of the patient included a temporal bone computed tomography (CT) scan, which revealed air in the vestibule and the ampulla of the superior and lateral semicircular canals. After failure of 5 months of conservative therapy, the patient was taken to the operating room for middle ear exploration and repacking of the cochleostomy site. The patient reported immediate and complete resolution of vertigo postoperatively. CONCLUSION: We present a case of disequilibrium as a result of an apparent perilymphatic fistula after cochlear implantation that was refractory to standard therapy. In such cases, appropriate workup should include a temporal bone CT scan to look for air in the vestibule or other abnormalities that may indicate potential etiology. Surprisingly, this patient had immediate and complete resolution of symptoms after surgery. If conservative therapy fails, middle ear exploration by way of an exploratory tympanotomy and packing of the cochleostomy with periosteum and muscle is a viable option and may lead to resolution of symptoms.
OBJECTIVES: Cochlear implantation has become a safe and effective method for the auditory rehabilitation of the profoundly hearing impaired. Incidence of disequilibrium and vertigo after cochlear implantation ranges from 13% to 74% in the literature. Most patients report resolution of these symptoms with medical therapy and vestibular rehabilitation. We present a case of persistent disequilibrium after cochlear implantation. Further workup of this patient revealed radiographic findings suggestive of a perilymphatic fistula, with immediate and complete resolution of symptoms after exploratory tympanotomy and packing around the cochleostomy. STUDY DESIGN: Case report. METHODS: A retrospective chart review of a patient with postoperative disequilibrium unresponsive to maximal medical and vestibular rehabilitation therapy. RESULTS: Diagnostic workup of the patient included a temporal bone computed tomography (CT) scan, which revealed air in the vestibule and the ampulla of the superior and lateral semicircular canals. After failure of 5 months of conservative therapy, the patient was taken to the operating room for middle ear exploration and repacking of the cochleostomy site. The patient reported immediate and complete resolution of vertigo postoperatively. CONCLUSION: We present a case of disequilibrium as a result of an apparent perilymphatic fistula after cochlear implantation that was refractory to standard therapy. In such cases, appropriate workup should include a temporal bone CT scan to look for air in the vestibule or other abnormalities that may indicate potential etiology. Surprisingly, this patient had immediate and complete resolution of symptoms after surgery. If conservative therapy fails, middle ear exploration by way of an exploratory tympanotomy and packing of the cochleostomy with periosteum and muscle is a viable option and may lead to resolution of symptoms.
Authors: Renee M Banakis Hartl; Nathaniel T Greene; Herman A Jenkins; Stephen P Cass; Daniel J Tollin Journal: Otol Neurotol Date: 2018-07 Impact factor: 2.311