Labyrinthectomy

[arushi1]

I am three years post acoustic neuroma surgery and my recent MR shows:

".....small area of thin enhancement, less prominent than on previous examination.  This may be small degree of residual tumor or possibility granulation tissue.  There is a small degree of high T1 signal w/in the basal turn of the cochlea and slightly in the vestibule pre contrast.  This does not correspond to any significant T2 signal abnormality and probably represents a small amount of blood products or proteinaceous debris.  Situations which may belead to this finding include entities such as radiation treatment or hemorrhagic labyrinthitis/vestibulitis."

My neurotologist wants to do a labyrinthectomy to make sure all of the vestibular nerve fibers have been removed along with acoustic nerve.  He says there is evidence of inflammation and with the symptoms I am having, oscillopsia, nystagmus, bouts of severe vertigo, nausea, exhaustion, this procedure will help me.  I forgot to mention to him that my most recent symptom is the feeling of being 10-feet tall when I am walking outside after a few minutes.  I wonder if that too will be corrected?

I am looking for answers as to my recovery as he states there are no guarantees this will help.  I am wondering what could be causing the inflammation and will this procedure help with inflammation?  Of course I should be asking him, but I thought about this after I hung up.  I am in the "thinking" stages before I make a decision and looking for more answers.  Hope you can help make my decision an easier one.  

[Enoch Choi, MD]

Thanks for letting us know, arushi1

it sounds like you have experts helping you, thank goodness

[Wear/a/Jimmy]

Why don't I think an audiologist did the testing....

Pure economics, that is why.

BUT, all that aside.

Arushi1,

My gut feeling is, you are in good hands and I mean that.

[arushi1]

Thank you for your responses.  Yes, my hearing has been tested by Audiologist.  My left ear is dead as a door nail.  Unfortunately my neurotologist tried to save it, but apparently the nerve was damaged during surgery.  My right ear shows signs of mild hearing loss w/in 4 mos. time (same Audiologist tested) loss is on the high end. I have aural fullness, constant tinnitus in the serviceable ear.  I am very concerned with these findings, I have signed up for lip reading classes to begin end of January for the "just in case" day of losing it all together.  The MR shows nothing is going on in that ear, my body tells me different, but what do I know.  My neurotologist doesn't seem concerned, as he states he's not sure what if anything is going on with it. Sympathetic response has been mentioned.  If  that's the case, I wonder if the vestibular nerve is acting up there too.  I am not worried, I feel I'm in good hands and the fact that I got you all to respond with a positive towards labyrinthectomy is all the better.  P.S. (I'm a she)

[Enoch Choi, MD]

why don't you think an audiologist has done the hearing test?

at PAMF, my clinic, only audiologists do these tests.  pre-surgery, it sounds like that's the most likely thing for patients in large group settings or university settings.

[Wear/a/Jimmy]

I do not guarantee his hearing has been tested by an audiologist, I only hope.  But I definitley agree with the rest of this thread.

[OtoHNS_MD]

I guarantee that arushi1's hearing has been tested by an audiologist.  If you have acoustic neuroma surgery, hearing is one of the primary concerns.  Labyrinthectomy will completely destroy any residual hearing you may have.  Depending on the pre operative audiogram and the surgical approach to the acoustic (actually vestibular schwannoma is a more appropriate term...same tumor as an acoustic neuroma) you may or may not have serviceable hearing.  There are different definitions of serviceable hearing and these depend on your ability to hear tones as well as understand or discriminate words.  If you lack serviceable hearing (or in some cases even if you have serviceable hearing) labyrinthectomy may be reasonable.  From what you describe, it seems like the goals of surgery are to eliminate any residual disease and improve you vestibular symptoms.  It is true, this may not work.  I agree with a second opinion if you're still having a hard time with the decision.  If you do this, it must be with a neuro otologist.  You probably already know this, but you'll need to be as safe as possible with your non operated ear...ear protection if exposed to loud noises, headphones, etc.

[Enoch Choi, MD]

Take Wear/a/Jimmy's advice and get tested by an audiologist.

[Wear/a/Jimmy]

Any hearing at all, does not really constitute hearing. In other words, if you have the ablitly to hear a tone, this does not mean you have the ability discriminate a spoken word, even if that word is amplified.

So, have your hearing tested, by an AUDIOLOGIST, such that your true hearing ability can be established, which will then better allow for decission making.

[Enoch Choi, MD]

If you have concerns, you may consider getting a second opinion from another ENT.

[OtoHNS_MD]

By the MRI findings as well as your symptoms, labyrinthectomy sounds like a reasonable (and probably best) option.  But just to consider all the options...do you have any hearing at all on that ear?  Have you tried any kinds of medications?  Also, don't be afraid to call your surgeon back or have another office visit to further discuss your surgery.