Surgical labyrinthectomy in the older patient

OBJECTIVE: Ablation of vestibular function is a highly efficacious option in the treatment of disabling vertigo arising from unilateral labyrinthine dysfunction. Regardless of the method used to ablate vestibular function, permanent posttreatment impairment of the balance function will develop in a number of treated patients. Many physicians who are involved in the care of the older patient with episodic vertigo are reluctant to recommend or perform a vestibular ablation procedure, because this treatment may result in permanent disequilibrium, which may be more detrimental to the older patient than the episodic vertigo. This study evaluates the outcome in older patients who underwent unilateral surgical labyrinthine ablation. METHODS: A retrospective analysis was done of the cases of 30 patients, all more than 60 years old, who underwent unilateral vestibular ablation because of disabling episodic vertigo by either transmastoid labyrinthectomy (n = 22) or transcanal labyrinthectomy (n = 8). RESULTS: Episodic vertigo was controlled in 95.5% of the patients in the transmastoid labyrinthectomy group and in 100% of those in the transcanal labyrinthectomy group. Postoperative imbalance was present in 22.7% of patients in the transmastoid labyrinthectomy group and in 62.5% of those in the transcanal labyrinthectomy group. CONCLUSIONS: Vestibular ablation is a viable option in the treatment of disabling vertigo in the older patient. A transmastoid labyrinthectomy may be preferable to a transcanal labyrinthectomy because the incidence of permanent posttreatment imbalance is less with a transmastoid labyrinthectomy.