Intraoperative auditory brainstem response monitoring during semicircular canal plugging surgery in treatment of Meniere’s disease

Abstract

Background

Three semicircular canal plugging (TSCP) is an optimized treatment for intractable Meniere’s disease (MD). However, 20–30% of patients experience hearing loss after TSCP, for reasons that remain unclear.

Objective

To evaluate hearing loss resulting from TSCP.

Subjects and methods

This study included 12 patients, which were diagnosed with definite MD and consented to TSCP surgery. Intraoperative auditory brainstem response (ABR) was monitored in each surgical procedure.

Results

After opening the mastoid cavity, the ABR threshold increased to 77.08 ± 9.88 dB nHL. The ABR threshold almost recovered to preoperative levels, to 68.33 ± 7.78 dB nHL, after completing TSC outlining. Exposure of three semicircular canal ‘blue lines’ had little effect on ABR threshold. The most prominent change on hearing loss was observed after mastoid outlining, when 41.67% of patients showed hearing loss ≥10 dB nHL. None of the patients showed a threshold shift ≥10 dB nHL following the last step.

Conclusions

TSCP operation itself caused little hearing damage.

Significance

Ruled out hearing loss as a result of the surgery itself. The reason why 20-30% of patients showed hearing loss in 2-year follow-up visit was not clear, although it may be due to serous fibrous labyrinthitis.

Chinese abstract

背景：三个半规管塞堵（TSCP）是顽固性美尼尔氏病（MD）的最佳治疗方法。但是, 有20–30％的患者在TSCP后出现听力下降, 其原因尚不清楚。

目的：评估由TSCP引起的听力损失。

材料和方法：本研究包括12例被确诊为MD并同意进行TSCP手术的患者。手术过程中监测术中听觉脑干反应（ABR）。

结果：打开乳突腔后, ABR阈值增加到77.08±9.88 dB nHL。完成TSC后, ABR阈值几乎恢复到术前水平, 达到68.33±7.78 dB nHL。暴露三个半规管“蓝线”对ABR阈值几乎没有影响。乳突勾画后观察到听力损失的最显著变化, 占41.67％的患者显示听力损失10 dB nHL。最后一个步骤之后, 没有患者出现阈值偏移10 dB nHL。

结论：TSCP手术本身对听力的损害很小。

意义：排除了听力损失是由于手术本身造成的。至于为什么20-30％的患者在2年的随访中并未发现听力损失, 其原因还不清楚, 尽管可能是浆液性纤维迷路炎。

Keywords:

• Auditory brainstem response
• triple semicircular canal plugging surgery
• Meniere's disease
• hearing loss

Author contributions

Xiaofei Li: wrote the manuscript and tables, performed the surgeries

Yafeng Lv: selected the patients, performed the surgeries

Ruijie Wang: performed hearing tests

Xiuhua Chao: performed hearing tests

Zhaomin Fan: participated in the design of the study, performed the surgeries

Haibo Wang: participated in the design of the study, performed the surgeries

Daogong Zhang: participated in the design of the study, selected the patients, performed the surgeries

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [Nos. 81670932, 81900940 and 81800905], the Focus on research and development plan in Shandong province [No. 2018GSF121027], Shandong Provincial Natural Science Foundation, China [ZR2019BH022], Taishan Scholars Program of Shandong Province [No. ts20130913], and the Key Project of Shandong Provincial Programs for Research and Development [2017CXGC1213].