People who experience a sudden hearing loss (SSNHL) are often treated with systemic steroids, which are taken orally. Studies however show that people with sudden sensorineural hearing loss (SSNHL) who do not respond to this treatment can benefit from intratympanic steroid injections. Studies carried out at universities in USA and Thailand show intratympanic steroid injections to be very effective and that the treatment does not have any side-effects.
Dr. David Haynes from Vanderbilt University Medical Center, Nashville, USA, carried out the study of 40 people who had experienced sudden sensorineural hearing loss (SSNHL). Overall, 40% showed some kind of improvement when treated with intratympanic steroid injections.
The surgery takes about an hour to perform. Most people take about a week off work to recover from surgery. The risk of hearing loss or major vertigo or a serious complication is quite low. We think ELS surgery is a good treatment option for patients who have failed maximal medical management and have good hearing. The success rate for vertigo control in patients with early Ménière’s disease is around 70% but long-term success rates are lower. So, 30% of patients may undergo surgery and have no significant improvement in their symptoms. While 30% of operated patients do not have early, complete control of their vertigo spells after ELS surgery, only about 15% of operated ears have enough continuing trouble to require additional surgical procedures.
Although from the name of the procedure one would expect that the entire vestibular nerve would be cut, in reality this is not always possible. According to Eisenmen (2001) there is evidence for retained vestibular function in about half of patients following nerve section or labyrinthectomy. Some of the fibers of the vestibular nerve run very close to the cochlear (hearing nerve), and because of this they may be spared. Saccule derived nerve fibers may be purposefully spared because they tend to run close to the cochlear nerve (Silverstein et al, 1994). Sometimes there is an attempt to cut these fibers at another site with a singular neurectomy. Singular neurectomies, however, are somewhat difficult and unreliable even in very experienced hands.