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Cochlear Corner

‘Greater Gains’ from Cochlear Implants in Patients with Menière's Disease

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doi: 10.1097/01.HJ.0000737576.59396.2e
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Menière's disease (MD) is an inner-ear disorder characterized by spontaneous vertigo, sensorineural hearing loss, and tinnitus, among other symptoms. For MD patients with severe hearing loss, cochlear implants (CI) are a means to rehabilitate hearing, though relatively few studies have explored post-implantation outcomes for these patients. Clinicians in this field have asked: Does MD affect patients’ experience with cochlear implants? A recent study has found that cochlear implantation “is a highly effective treatment option for patients with MD” and that “CI provides greater gains in functional hearing for patients with MD” compared with CI users with other hearing pathologies (Otol Neurotol. 2020 Oct;41[9]:1296-1304. doi: 10.1097/MAO.0000000000002750). These findings provide fresh insights into hearing rehabilitation decision-making for MD patients—a task that has been traditionally tricky for both clinicians and patients.

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GUIDING PATIENTS IN DECISION MAKING

“Hearing rehabilitation among Menière's patients is a clinical challenge, even for an experienced neurotologist,” said study co-author Arminé Kocharyan, MD, who is a resident at the Univeristy Hospitals Cleveland Medical Center. “There are conflicting data regarding cochlear implantation benefits in this patient population. Decision-making becomes more challenging depending on the disease process and domination of symptoms that most affect the quality of life.”

For instance, the new paper cited a previous study that found MD patients to have “significantly worse word recognition scores compared with [the] general implanted population,” though “a subsequent stratified analysis found that patients with active MD had comparable outcomes to the general CI population.”

Amid conflicting data from previous researches, Kocharyan's team hoped to aid patients’ decision-making regarding cochlear implants as a hearing treatment option.

“This paper was aimed at studying cochlear implantation outcomes in this patient population and put evidence behind decision-making when counseling these patients regarding surgical rehabilitation,” Kocharyan told The Hearing Journal.

BETTER OUTCOMES IN MENIÈRE'S PATIENTS

Through a retrospective chart review, the study compared preoperative and postoperative audiometric measurements of patients with MD versus those of patients with other hearing pathologies. The results showed better outcomes for MD patients: 16.1 dB lower speech reception threshold (SRT), 12.2 percent higher word recognition scores (WRS), and 16.8 percent higher sentence recognition scores (SRS).

“Our study is the first to observe that patients with MD may receive greater benefit from cochlear implantation compared with age-matched controls,” the researchers noted.

The authors also analyzed the data to find any potential impact of disease status on implantation outcomes. Menière's disease tends to become inactive—or “burn out”—over several years, with some of its symptoms becoming less severe or less frequent. The researchers explored whether active or inactive disease status affected any benefit gained from cochlear implants.

“A stratified analysis did not detect any interaction between disease status and cochlear implantation in the Menière's population for SRT, WRS, SRS, and [pure tone average],” the paper found.

However, Kocharyan shared that “[w]hen considering narrowed data on three best performances, patients with active Menière's had a greater gain in speech reception scores compared to those with inactive disease. This can be explained by more preserved cochlear and retro-cochlear reserve in patients with active disease compared to ‘burned out’ Menière's who are further advanced in their disease process.”

However, the conclusions in the current paper give MD patients a better idea of their prospective hearing experience with cochlear implants.

“Cochlear implantation is an effective option for rehabilitation among patients with Menière's disease, and this patient population performs as well, if not better than the general CI population,” noted Kocharyan. “Most importantly, active status is not a contraindication to cochlear implantation if other criteria are met and appropriate counseling is provided.”

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