Labyrinthectomy

Labyrinthectomy is a surgical procedure that destroys the inner ear labyrinth to abolish vertigo originating from unilateral vestibular dysfunction, most often in patients with disabling Menière’s disease who have nonserviceable hearing in the affected ear. By removing or ablating the vestibular apparatus (the semicircular canals and vestibule), the procedure eliminates vestibular input from the operated side, providing relief from vertigo at the cost of permanent hearing loss on that side.

Indications for labyrinthectomy include medically intractable and disabling vertigo where other treatments have failed and the affected ear has little or no useful hearing. It is typically considered only after careful assessment by an otologic surgeon and when preserving hearing is not feasible. The classic approach is a translabyrinthine procedure through the temporal bone, often following a mastoidectomy, which provides access to the labyrinth and, if needed, the internal auditory canal. In this context, the procedure is destructive to the labyrinth and cochlea, making it unsuitable for patients with useful contralateral hearing.

Postoperative management emphasizes vestibular rehabilitation to promote central compensation for loss of unilateral vestibular input. Most patients experience substantial relief of vertigo, with improvement in functional status, though some residual disequilibrium may persist during recovery.

Complications can include facial nerve injury, cerebrospinal fluid leak, infection, taste disturbance, and permanent deafness in the operated ear. Alternatives for vertigo control include vestibular nerve section or chemical ablation (such as intratympanic gentamicin), which aim to reduce vertigo while potentially preserving hearing in selected cases.