Is Meniere's Disease a Contraindication to Stapedectomy?

Objective: Review surgical outcomes of stapedectomy for otosclerosis in patients with Meniere's disease. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Patients with otosclerosis and Meniere's disease undergoing stapedectomy between 2010 and 2017. Intervention: Stapedectomy. Main Outcome Measures: Pre- and postoperative hearing and complications. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone frequency, pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Results: Among 1,499 patients with otosclerosis, the incidence of concomitant Meniere's disease was 1.7%. Fifteen patients with otosclerosis and Meniere's disease underwent stapedectomy, 12 primary and three revisions. Mean AC PTA was 43 dB preoperatively, and 25 dB postoperatively (p = 0.0007), while the ABG improved on average from 20 to 5 dB (p = 0.0001). There was no significant difference in BC PTA or WRS postoperatively. Two patients experienced fluctuation of hearing in the postoperative period, one of which resolved with a course of steroids. The mean follow-up time was 41 months. Conclusions: In patients with otosclerosis and Meniere's disease, stapedectomy provides excellent hearing outcomes in a majority of patients. As is characteristic of Meniere's disease, some patients will continue to experience fluctuating hearing postoperatively, which may progress to severe sensorineural hearing loss. Meniere's disease may not be an absolute contraindication to stapes surgery.