What are the Tests Required Before Labyrinthectomy?

The following tests are recommended prior to carrying out labyrinthectomy:

Otoscopy: The ENT (Ear, Nose and Throat) specialist will thoroughly examine the affected ear for any abnormalities using an otoscope, which is an instrument used for visual examination of the outer ear and eardrum
Audiometry: This test determines the extent of hearing loss by assessing how sounds of different volumes, intensities and pitches are perceived by the patient. Audiometry helps in the decision-making process whether to proceed with the surgery or not
Tympanometry: This test measures the effect of minute changes in air pressure on the eardrum
Tuning Fork Test: A Vibrating Tuning Fork can be used for assessing the degree of hearing loss and region of the ear that is affected
CT / MRI: Computed tomography (CT) scans or Magnetic Resonance Imaging (MRI) are powerful imaging techniques that are capable of generating crisp and clear images of the internal structures of the ear. CT/MRI can be used for guiding surgery, as well as ruling out the possibility of Retro cochlear lesions

How do you Prepare Before Labyrinthectomy?

Since Labyrinthectomy is an elective surgery, there is usually ample time to prepare for the operation. Once surgery is finalized, the surgeon will carry out a thorough physical examination to assess whether the patient is in a stable condition to undergo surgery. If the patient is a smoker, smoking should be stopped several days before the surgery or quit altogether. Some medicines that should be avoided or require adjustment of the dosage and timing, include the following:

NSAIDs
Insulin
Antacids
Clopidogrel

The Surgeon should be informed regarding the following:

If the patient is on anticoagulants such as Heparin or Warfarin
Allergy to any drugs

The Patient should be on an empty stomach and should not have eaten after midnight preceding the morning of the procedure. Drinking of water or other liquids should be stopped at least 4 hours before the procedure.

The Surgeon will explain the procedure prior to the surgery and an informed consent form will need to be signed. The informed consent is very important since the surgery will inevitably result in loss of hearing on the side operated.

What Happens During Labyrinthectomy?

The Goal of Surgery is to stop the production of sensory impulses or prevent its transmission from the inner ear to the brain. Surgery is carried out under general anesthesia. Surgical time is approximately 1.5-2 hours.

Surgery involves either a Trans canal or a Trans mastoid approach. The Trans canal approach is most commonly used, while the Trans mastoid approach is reserved for patients who have narrow canals/openings. In either approach, the aim is to remove the vestibular end organs.

During the procedure, the landmarks of the inner ear are carefully mapped and the required structures are removed with a drill under real-time CT/MRI guidance. Since damage to the facial nerve can cause serious complications, surgeons routinely use a facial nerve monitor during the surgery to ensure that the nerve is preserved. The surgeon ensures that all the neuroepithelium is removed to prevent recurrence of vertigo due to persistence of neuronal activity. A postoperative ice water caloric test is valuable for ascertaining whether the neuroepithelium has been completely removed.

Labyrinthectomy has a success rate of 90.5 percent or higher. Long-term outcomes are comparable to those of vestibular neurectomy. However, there may be disequilibrium (difficulty in balancing) due to inadequate central vestibular compensation. Incidence of disequilibrium following labyrinthectomy can range between 20-78 percent.

What Happens after Labyrinthectomy?

After the Surgery, a plastic ‘cup’ dressing is placed over the ear, which can be removed after 24 hours
The operated ear should not be exposed to water until complete healing
Ibuprofen / paracetamol combination can be used to control pain and inflammation
Anti-emetics may be given to prevent vomiting and nausea
Laxatives will help to ease constipation, which can exert pressure on the ear
Antibiotics may be required to control infection if present
Head should be kept raised at 30º while lying down for at least 2 weeks
A Walker may be required for walking, following the surgery
Balance therapy may be recommended to fully regain balance
The Duration of hospitalization is usually 2-3 days
Complete recovery may take 4-6 weeks
The Doctor will advise a follow-up visit in 5 weeks

Precautions after Surgery

Ladders and heights should be avoided until complete balance is regained
Running, contact sports, aerobic exercises, and lifting heavy objects should be avoided for at least 1 month after surgery
Blowing of the nose should be avoided for one week post-surgery so that pressure is not exerted on the ear
The mouth should be opened while coughing or sneezing for the first week after surgery
Air travel is not permitted for at least one month following surgery