Vestibular neurectomy vs. chemical labyrinthectomy in the treatment of disabling Menie `re’s disease: A long-term comparative study Se ´bastien Schmerber * , Georges Dumas, Nils Morel, Karim Chahine, Alexandre Karkas Department of Otorhinolaryngology, Grenoble University Medical Center, BP 217 - 38043 Grenoble Cedex 9, France Received 3 February 2008; accepted 20 August 2008 Available online 20 November 2008 Abstract Objective: To compare the efficiency of vestibular neurectomy (VN) and chemical labyrinthectomy (CL) in the treatment of Menie `re’s disease’s disabling vertigo, and to assess their subsequent effects on hearing. Methods: This is a retrospective study of 58 VN procedures and 35 CL procedures. Treatment results were assessed by caloric testing and pure-tone audiometry performed before and after treatment. Subjective success was defined by the number of recurrent attacks of vertigo and by the AAO-HNS vertigo scale. Results: Caloric testing revealed strong vestibular hyporeflexia in 91.0% of VN cases and 86.0% of CL cases. Vertigo recurred in 7.0% of cases in the VN group and in 11.4% of cases in the CL group. Mean pure-tone auditory thresholds increased from 45.00 dB HL to 50.84 dB HL ( p = 0.19) in the VN group and from 69.11 dB HL to 74.51 dB HL ( p = 0.41) in the CL group. Conclusion: Vestibular neurectomy and chemical labyrinthectomy offer similar control of vertigo in patients with Menie `re’s disease. CL is a simple, minimally invasive procedure that emerges as an effective method for treating Menie `re’s disabling vertigo without causing significant hearing deterioration. # 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Menie `re’s disease; Vestibular neurectomy; Intratympanic gentamicin; Vertigo 1. Introduction The treatment of disabling vertigo in Menie `re’s disease is a challenge to otologists. The optimal treatment modality is one that is minimally invasive, and provides adequate control of vertigo without effect on hearing. Although the symptoms of Menie `re’s disease resolve spontaneously within 8 years in 70% of cases, treatment of recurrent vertigo attacks is often necessary to improve the patient’s quality of life [1]. Vestibular neurectomy (VN), a radical denervation procedure, has been associated with vertigo cure rates as high as 95% [2]. Since 1986, patients with Menie `re’s disease presenting to our tertiary medical center with disabling vertigo have been offered VN as a therapeutic option. Our team of otologists has been performing this procedure through the retro-sigmoid approach since 1992. Chemical labyr- inthectomy (CL) was adopted by our team of otologists as an alternative therapeutic modality since 1997. This procedure has been performed by transtympanic administration of gentamicin following a 7-episode protocol with intervals of 15–30 days. Both VN and CL aim at the ablation of the abnormal afferent neural impulses of the vestibular system and the subsequent induction of central compensation [3]. This study compares the long-term results of VN and CL with regard to the control of vertigo symptoms, the impact on hearing, and the occurrence of treatment complications. 2. Patients and methods Ninety-three patients were included in this study; 58 patients were treated with VN (Group 1), 35 patients were www.elsevier.com/locate/anl Auris Nasus Larynx 36 (2009) 400–405 * Corresponding author at: Service ORL CHU A. Michallon, BP 217, F- 38043 Grenoble Cedex 9, France. Tel.: +33 4 76 76 56 62; fax: +33 4 76 76 51 20. E-mail addresses: SSchmerber@chu-grenoble.fr, schmerber@chu-grenoble.fr (S. Schmerber). 0385-8146/$ – see front matter # 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.anl.2008.08.001