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Results in labyrinthine cryosurgery monitored by evoked response
Author(s) -
Tabor James R.,
Best Lavar,
Donohoe Robert W.
Publication year - 1972
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1288/00005537-197208000-00006
Subject(s) - medicine , cryosurgery , electronystagmography , vertigo , audiology , vestibular system , tinnitus , surgery , stimulus (psychology) , caloric theory , psychology , psychotherapist
Cryosurgery is one conservative approach for Ménière's disease designed to control vertigo without adversely affecting the hearing in most cases. Report is made of 47 consecutive cases of cryosurgery. All patients were unresponsive to medical therapy. During the surgical procedure, the hearing is monitored at 2,000 cycles per second, and the vestibular function is monitored by evoked response to a loud click stimuli. Initial testing for threshold at 2,000 cycles and to a click stimulus is done by the evoked response. An initial freeze at —160°C. for two minutes is done, and the vestibular and auditory function is retested. A repeat freeze is completed unless there is a definite hearing change or the vestibular recording changes as evinced by the evoked response. If necessary, a third freeze is done, depending upon vestibular and auditory threshold changes. By this method a significant improvement of vertiginous symptoms resulted in 76 to 80 percent of the patients. The results of postoperative electronystagmography suggest an increase in unilateral weakness, but all cases showed a caloric response. In general, the hearing postoperatively continued to fluctuate as before surgery, accompanied by tinnitus, fullness, and recruitment. Morbidity in the way of hearing loss and temporary facial paralysis occurs in approximately 10 percent of the patients treated in this manner. Until a more knowledgeable approach to Ménière's disease is forthcoming, cryosurgery to the lateral semicircular canal still holds a position in the armamentarium for the treatment of patients who have incapacitating vertigo.