By Marcello Cherchi, MD PhD
For patients
For some inner ear diseases, an otolaryngologist may consider surgically removing the entire inner ear (called a labyrinthectomy), or may try to disconnect only the balance-related fibers between the ear and the brain (called a vestibular neurectomy).
For clinicians
Labyrinthectomy refers to the surgical removal of the labyrinth itself. This can be accomplished via a transcanal or transmastoid approach (Alarcon et al. 2017).
Vestibular neurectomy refers to surgical interruption (neurotomy) or removal (resection) of the vestibular nerve. This can be accomplished by several techniques, including via the middle cranial fossa, retrolabyrinthine or retrosigmoid approaches (Alarcon et al. 2017).
The techniques for labyrinthectomy and vestibular neurectomy have evolved over decades (Jackler and Whinney 2001).
A common indication for these procedures is medically intractable vertiginous episodes of Ménière’s disease. Labyrinthectomy and vestibular neurectomy are invasive, purposefully destructive procedures, and are irreversible.
The intention of vestibular neurectomy is to disconnect vestibular afferent fibers while leaving afferent cochlear fibers intact — in other words, selective vestibular ablation with hearing preservation.
The intention of labyrinthectomy is removal of the entire inner ear end organ. Some surgeons may consider this in cases of Ménière’s disease when there is no salvageable hearing in the affected ear.
References
Alarcon AV, Hidalgo LO, Arevalo RJ, Diaz MP (2017) Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms. Int Arch Otorhinolaryngol 21: 184-190. doi: 10.1055/s-0037-1599242
Jackler RK, Whinney D (2001) A century of eighth nerve surgery. Otol Neurotol 22: 401-16. doi: 10.1097/00129492-200105000-00023
