Abstract
Introduction
Cochlear implantation has demonstrated benefit for restoring hearing in patients with Ménière’s disease. We sought to examine disease and management factors that may influence postoperative speech performance and vertigo control.
Methods
A single-center retrospective chart review between 2010 and 2023 of patients with Ménière’s disease receiving a cochlear implant (CI). The primary outcome was 1-year postoperative word recognition score on Consonant-Nucleus-Consonant (CNC) testing. Postoperative vertigo control was assessed as a secondary outcome. Variables including concurrent labyrinthectomy, pre- and postoperative Ménière’s disease symptoms and treatments, duration of deafness, and hearing loss laterality were analyzed.
Results
Twenty-five patients were identified over the study period. Of those, 9 (36%) also underwent labyrinthectomy; 6 (67%) were performed simultaneously with CI and 3 (33%) received a CI following surgical ablation. There was a statistically significant (p = 0.03) higher rate of bilateral Ménière’s disease in the CI-only cohort (n = 9, 56%), compared to the cochlear implant and labyrinthectomy (CI + L) cohort (n = 1, 11%). There was also a higher rate of preoperative uncontrolled vertigo (n = 5, 56%) in the CI + L cohort compared to the CI-only cohort (n = 3, 20%), although this did not reach statistical significance (p = 0.08). The average pre- and postoperative CNC score for the CI + L cohort was 3.6 (SD 5.9) and 36.7 (SD 17.5), respectively, and 7.1 (SD 10.1) and 62.1 (SD 14.3) for the CI-only group. There was a statistically significant difference noted at most recent CNC follow-up testing (p = 0.01) between the CI + L and CI-only group.
Conclusion
Patients with Ménière’s disease meeting CI candidacy criteria may undergo CI safely and achieve speech performance benefit. A trend toward worse performance in patients who undergo concurrent labyrinthectomy with CI compared to CI alone was seen which warrants further study.
Keywords: Ménière’s disease, Cochlear implant, Labyrinthectomy, Endolymphatic hydrops, Vertigo
Introduction
Patients with Ménière’s disease can suffer from profound sensorineural hearing loss, bothersome tinnitus, and debilitating vestibular symptoms [1]. The course and severity of disease is heterogenous, with a variety of medical and surgical treatments available [1]. Nonablative therapies seek to reduce the frequency and severity of audiologic and vestibular symptoms; however, the strength of evidence supporting these measures is limited and many patients continue to experience attacks [1]. Cochlear implantation (CI) and labyrinthectomy provide the potential benefits of definitive vertigo control while also rehabilitating hearing in patients with non-serviceable hearing. However, definitive and/or ablative therapies are often not recommended, except in rarer refractory and/or end stage settings when patients are debilitated by vestibular symptoms [1, 2].
CI has demonstrated benefit for restoring hearing in patients with Ménière’s disease [3–6]. A systematic review and meta-analysis in 2021 of CI in patients with Ménière’s disease found those who also underwent labyrinthectomy had comparable hearing outcomes to patients without Ménière’s disease [7]. More data were recommended to investigate the impact of labyrinthectomy timing on outcomes due to the possibility of postsurgical changes [7]. Small studies exploring these timing nuances have thus far demonstrated mixed results [7–13]. A meta-analysis of patients who underwent labyrinthectomy and simultaneous or sequential CI had results that contradicted Villavisanis et al. [7], noting that performance may be worse than traditional CI candidates [12]. Due to conflicting evidence and low case numbers in meta-analysis to date, we sought to characterize our experience performing CI in patients with Ménière’s disease, examining disease and management factors that may influence postoperative speech performance and vertigo control.
Methods
Study approval was received by the NYU Langone Health Institutional Review Board (IRB# s23-01394). A single-center retrospective chart review was completed for patients with Ménière’s disease that received a CI between January 2010 and October 2023. Twenty-five patients identified over the study period had relevant data collected from their electronic chart, including demographic data (age, sex), duration of Ménière’s disease and duration of severe-profound HL in the affected ear prior to CI, disease symptoms and severity, temporal relationship of CI to labyrinthectomy, additional Ménière’s treatments, surgical details such as implant device and abnormalities/complications, pre- and postoperative speech recognition scores, postoperative tinnitus suppression, and vertigo control. Duration of deafness was calculated for patients that developed an acute severe to profound sensorineural hearing loss that did not recover, without the use of hearing aids before candidacy evaluation. If patients had a gradual hearing loss, or large hearing fluctuations that made it difficult to determine hearing loss onset, they were excluded from this calculation. Duration of Ménière’s disease was calculated from the time the diagnosis was made. The primary outcome was 1 year, postoperative word recognition score on Consonant-Nucleus-Consonant (CNC) testing [14]. For patients without a 1-year postoperative CNC score, their most recent test was utilized and time from surgery documented. Additional data such as speech perception of sentences AzBio in quiet and noise (+10 dB SNR) and change in speech recognition were completed for secondary analysis [15].
Preoperative vertigo was initially placed into three categories: “none” reflecting no vertigo attacks occurring at the time of CI, “controlled” reflecting less than 1 episode per week or patient-reported low impact on quality of life, and “uncontrolled” reflecting multiple vertigo attacks per week or patient-reported significant impact on quality of life. Statistical analysis of preoperative vertigo compared patients with no vertigo or controlled vertigo against patients with uncontrolled vertigo. Postoperative vertigo based on patient report was categorized as: no vertigo or imbalance, persistent imbalance only, and persistent vertigo (+/− imbalance). Statistical analysis of postoperative vertigo compared patients with no vertigo or imbalance against patients with persistent imbalance or persistent vertigo.
Descriptive statistics were calculated using Microsoft Excel v 16.78.3. Comparisons were made utilizing an RStudio (Version 2024.04.2+764), using a Mann-Whitney U test, with a p value of <0.05 considered statistically significant. Non-comparative data were gathered and collated in table format for presentation utilizing mean and standard deviation or range.
Regarding procedural steps, when a labyrinthectomy was performed, a postauricular trans-mastoid approach was utilized. The middle fossa plate and posterior fossa plate are identified to provide a large exposure. The three semicircular canals and vestibule are subsequently excavated, utilizing a diamond burr to carefully remove any active nerve endings. Inspection to ensure no CSF leak requiring repair is completed. Plugging the labyrinthectomy side of the vestibule with temporalis muscle and fascia is based on surgeon preference and was therefore isolated as a study variable for outcome comparison. CI insertion itself is otherwise performed in a standard manner, utilizing a facial recess approach, and peri-round window cochleostomy.
Results
Sixteen patients (64%) identified over the study period had a CI only, and 9 patients (36%) had a CI and surgical labyrinthectomy (CI + L). In the CI + L cohort, 6 (67%) patients had a labyrinthectomy performed simultaneously with the CI, while 3 (33%) patients had labyrinthectomy performed prior to the CI. The time observed between labyrinthectomy and subsequent CI for the 3 patients in the sequential setting was 3 months, 3 years, and 35 years. Two patients in the CI-only group underwent cochlear gentamycin injection at the time of surgery. A breakdown of patient demographic information and Ménière’s characterization is found in Table 1. For patients who experienced acute hearing loss, the average duration of deafness (severe to profound hearing loss) in the CI-only group was longer (11.9 years, n = 10) than patients in the CI + L group (3.6 years, n = 3), although this was not statistically significant (p = 0.17). For patients with progressive hearing loss, 4 patients had CI only, and 3 patients underwent CI and labyrinthectomy once CI criteria were met. The duration of deafness for the remaining patients could not be characterized accurately based on medical records and were excluded from duration calculations.
Table 1.
Demographic information and Ménière’s characterization
| | Lab and CI | CI only | Comparison, p value |
|---|---|---|---|
| Total patients | 9 | 16 | – |
| Age, years, mean (range) | 55.4 (31.9–74.9) | 65.7 (44.1–82.9) | 0.08 |
| Disease timeline, mean (range) | |||
| Duration of Ménière’s | 14.2 (4.4–39.9) | 22.5 (6.2–76.9) | 0.09 |
| Duration of deafnessa | 3.6 (0.8–7.0) | 11.9 (0.5–29.0) | 0.17 |
| Sex, n (%) | |||
| Male | 2 (22) | 7 (44) | 0.31 |
| Female | 7 (78) | 9 (56) | |
| Disease bilaterally, n (%) | |||
| Unilateral | 8 (89) | 7 (44) | 0.03 |
| Bilateral | 1 (11) | 9 (56) | |
| Preoperative vertigo, n (%) | 5 (56) | 3 (21) | 0.08 |
| Controlledb | 1 (11) | 6 (40) | – |
| Uncontrolledc | 5 (56) | 3 (20) | |
| None | 3 (33) | 6 (40) | |
| Additional symptoms, n (%) | |||
| Tinnitus | 6 (86) | 13 (81) | 0.84 |
| Migraine | 4 (44) | 2 (13) | 0.08 |
| Previous Ménière’s treatment, n (%) | |||
| HCTZ | 6 (67) | 9 (69) | 0.93 |
| Diamox | 1 (11) | 1 (8) | 0.84 |
| SERC | 0 (0) | 2 (15) | 0.25 |
| PO steroid | 2 (22) | 3 (23) | 1.0 |
| IT steroid | 1 (11) | 3 (23) | 0.52 |
| IT gentamycin | 4 (44) | 1 (8) | 0.053 |
| Endolymphatic sac surgery | 5 (56) | 2 (15) | 0.06 |
| Vestibular neurectomy | 0 (0) | 1 (8) | 0.46 |
| Other | 0 (0) | 2 (15) | 0.25 |
Other: 1 patient was treated with valacyclovir at an outside center. Another patient received hyperbaric oxygen, anakinra, and plasmapheresis from outside center.
aUntil implant.
bControlled: mild less than 1/week or patient reports low impact on QOL.
cUncontrolled: multiple attacks/week and significant impact on QOL.
There was a statistically significant (p = 0.03) higher rate of bilateral Ménière’s disease in the CI-only cohort (n = 9, 56%), compared to the CI + L cohort (n = 1, 11%) (Table 1). While there was a higher percentage of patients with preoperative uncontrolled vertigo in the CI + L cohort (n = 5, 56%) than the CI-only cohort (n = 3, 20%), this did not reach statistical significance (n = 0.08). There was no statistical difference found between preoperative rates of tinnitus (p = 0.84) or coinciding migraine history (p = 0.08) (Table 1). There was also no statistically significant difference found in average number of prior Ménière’s treatments for the CI + L cohort (avg. 2.1, SD 1.3) and CI-only cohort (avg. 2.0, SD 1.1; p = 0.75).
Surgical and postoperative details can be found in Table 2. The mean length of stay for patients receiving CI + L was 1 day and 0.3 days for the CI-only group. There was no statistical difference found between these groups; however, a statistically significant difference was found when patients with sequential CI following labyrinthectomy were removed from analysis (Table 4). There was a higher percentage of patients that received a CI under sedation in the CI-only group (n = 5, 31%) compared to CI + L (n = 0, 0%), although this was not statistically significant (p = 0.07). Two intraoperative complications occurred in the CI + L group, including a CSF leak at the lateral IAC which was repaired with a muscle patch at time of surgery, and a tympanic membrane perforation which resolved spontaneously, both resulting in no additional morbidity. Two patients in the CI + L group were noted to have basal turn ossification; one requiring partial basal turn drill out to achieve electrode insertion, while another required scala vestibuli insertion. Both of these patients with ossification had undergone CI following initial labyrinthectomy at an outside center. The third patient who underwent CI after prior labyrinthectomy had a sleeper electrode placed at time of labyrinthectomy and did not have concern of ossification during CI surgery.
Table 2.
Surgical and postoperative details
| | Lab and CI | CI only | Comparison, p value |
|---|---|---|---|
| Length of stay, mean (range) | 1 (0–3) | 0.3 (0–2) | 0.06 |
| Implant laterality, n (%) | |||
| Left | 3 (33) | 7 (44) | 0.64 |
| Right | 6 (67) | 9 (56) | |
| Operative anesthetic, n (%) | |||
| General | 9 (100) | 11 (69) | 0.07 |
| MAC | 0 (0) | 5 (31) | |
| Operative abnormality/complication, n (%) | 3 (33)a | 0 (0) | 0.02 |
| TM perforation | 1 (11) | 0 (0) | – |
| Basal turn ossification with scala tympani insertion | 1 (11) | 0 (0) | |
| Basal turn ossification requiring scala vestibuli insertion | 1 (11) | 0 (0) | |
| CSF leak at lateral IAC requiring repair | 1 (11) | 0 (0) | |
| Postoperative imbalance/vertigo, n (%) | 3 (38) | 7 (44) | 0.53 |
| Persistent vertigo | 1 (13) | 6 (38) | – |
| Persistent imbalance | 2 (25) | 1 (6) | |
| No vertigo or imbalance | 5 (63) | 9 (56) | |
| Other postoperative details, n (%) | |||
| Vestibular rehab | 4 (44) | 6 (38) | 0.76 |
| Tinnitus suppression | 5 (83) | 5 (42) | 0.11 |
| Labyrinthectomy timing, n (%) | |||
| Simultaneous | 6 (67) | NA | |
| Delayed CIb | 3 (33) | NA | |
| Implant device, n (%) | |||
| Cochlear Freedom 24RE | 2 (22) | – | |
| Cochlear Freedom 422 | – | 1 (6) | |
| Cochlear Profile 512 | 1 (11) | 2 (12) | |
| Cochlear Profile 532 | – | 4 (25) | |
| Cochlear Profile 612 | 3 (33) | 2 (12) | |
| Cochlear Profile 632 | 1 (11) | 4 (25) | |
| MED-EL Flex 24 | – | 1 (6) | |
| MED-EL FLEXSOFT | 1 (11) | – | |
| AB 90K MS | 1 (11) | 1 (6) | |
| AB Ultra 3D MS | – | 1 (6) | |
aSome patients had more than one complication noted.
bDelays were 0.25, 3, and 25 years.
Table 4.
Subanalysis of simultaneous CI
| | Simultaneous labyrinthectomy and CI | CI only | Performance change | ||
|---|---|---|---|---|---|
| n | mean (SD) | n | mean (SD) | p value | |
| Length of stay | |||||
| Days | 6 | 1.5 (1.5) | 15 | 0.27 (0.6) | 0.01 |
| Speech performance | |||||
| Preoperative CNC score | 6 | 5.3 (6.6) | 15 | 7.1 (10.1) | 1.0 |
| Postoperative CNC score | 5 | 30.8 (11.2) | 14 | 62.1 (16.4) | 0.01 |
| Change in CNC score | 5 | 24.4 (14.2) | 13 | 53.1 (20.3) | 0.02 |
There was no statistically significant difference between CI and CI + L cohorts in terms of postoperative tinnitus suppression (p = 0.11), postoperative imbalance/vertigo (p = 0.53), or utilization of vestibular rehab (p = 0.76) (Table 2). The 3 patients in the CI + L cohort with no vertigo prior to CI were the same 3 patients that had undergone labyrinthectomy prior to CI. Breaking down postoperative vertigo/imbalance symptoms further, there was only 1 patient in the CI + L cohort with persistent vertigo alone. This developed in a delayed fashion and was thought to be secondary to comorbid vestibular migraine due to coinciding migraine symptoms and no contralateral hearing changes. Five patients (63%) had no vertigo or imbalance over time in the CI + L cohort, and 2 patients (25%) had persistent imbalance. Of the 16 patients in the CI-only cohort, 9 had preoperative vertigo symptoms. Of the 9 patients in the CI-only cohort with preoperative vertigo, 6 patients (38%) continued to have persistent vertigo episodes, 1 patient (6%) had persistent imbalance, and 9 patients (56%) had no vertigo or imbalance symptoms. Of note, the patient with persistent imbalance in the CI-only group was walker-dependent preoperatively secondary to hydrocephalus which had been treated with ventriculoperitoneal shunt.
A summary of speech perception results can be found in Table 3. Of the patients with available data, no statistically significant difference was found for preoperative CNC performance (p = 0.54) between the CI + L and CI-only group. The average post-op CNC score was higher in the CI-only group (62.1%) compared to the CI + L group (36.7%) which reached statistical significance (n = 0.01). The change in pre- and postoperative CNC performance also demonstrated a statistically significant difference (p = 0.048) between the CI-only group (Δ53.1) and CI + L group (Δ31.3). The average pre- and postoperative CNC score for the CI + L cohort was 3.6 (SD 5.9) and 36.7 (SD 17.5), respectively, while the CI-only group cohort’s scores were 7.1 (SD 10.1) and 62.1 (SD 14.3). Subgroup analysis of the CI + L cohort was completed, in which patients undergoing sequential CI following previous labyrinthectomy were excluded (Table 4). This demonstrated a wider gap in postoperative CNC scores (p = 0.01) and change in CNC scores (p = 0.02) between patients undergoing simultaneous labyrinthectomy and CI (mean 30.8, SD 11.2; mean 24.4, SD 14.2) versus a CI alone (mean 62.1, SD 16.4; mean 53.1, SD 20.3). There was no statistically significant difference found between preoperative performance between the two groups (p = 1.0).
Table 3.
Speech perception testing
| | Labyrinthectomy and CI | CI only | p value | ||
|---|---|---|---|---|---|
| n b | mean (SD) | n b | mean (SD) | ||
| Preoperative performance | |||||
| CNC | 9 | 3.6 (5.9) | 15 | 7.1 (10.1) | 0.54 |
| AzBio (quiet), % | 4 | 11.0 (14.3) | 13 | 15.2 (26) | 0.85 |
| AzBio (noise), % | 4 | 0 (0) | 11 | 0.7 (1.8) | 0.44 |
| Most recent performancea | |||||
| CNC | 6 | 36.7 (17.5) | 14 | 62.1 (16.4) | 0.01 |
| AzBio (quiet), % | 6 | 59.0 (22.7) | 12 | 79.2 (14.3) | 0.07 |
| AzBio (noise), % | 1 | 78.0 (NA) | 9 | 63.7 (17.5) | – |
| Performance change | |||||
| CNC | 6 | 31.3 (21.2) | 13 | 53.1 (20.3) | 0.048 |
| AzBio (quiet), % | 2 | 17.5 (14.8) | 10 | 59.5 (33.3) | 0.16 |
| AzBio (noise), % | 0 | NA | 6 | 63.8 (20.7) | – |
Noise was presented at a +10 dB SNR; CNC, Consonant-Nucleus-Consonant Test (Peterson and Lehiste [14]); AzBio Sentences (Spahr et al. [15]).
aMean (SD) follow-up: labyrinthectomy and cochlear implant: 39.6 months (45); cochlear implant only: 23.3 months (20.8). No statistical difference between FY time (p: 0.36).
bNot all patients had all tests completed or available.
One patient who underwent CI as a second procedure following labyrinthectomy had a 3-month post-op CNC of 66%, which was in keeping with the mean score for patients undergoing CI alone. The only other patient who had postoperative speech performance available following sequential CI after labyrinthectomy was Spanish speaking, achieving a Spanish HINT score of 88% 3 months following surgery. Two patients in the CI-only group, but injection of gentamycin into the cochlea achieved postoperative CNC scores of 68% and 62% which did not differ from the remaining cohort (p = 0.58). Both patients required postoperative admission lasting 1–2 days due to vertiginous symptoms.
Discussion
Ménière’s disease symptoms are unpredictable, with fluctuating symptomatology and severity which often plateaus over time [1]. Permanent ablative options are typically reserved for severe or refractory cases to preserve immediate and long-term quality of life [1, 2]. The present study supports the benefit in speech performance demonstrated in patients with Ménière’s disease meeting CI criteria while highlighting the importance of tailoring treatment to individual symptoms and preferences. We observed a trend of worse performance in patients who undergo concurrent labyrinthectomy with CI compared to CI alone and consider possible etiologies, such as a higher rate of single-sided deafness (SSD), and mechanical trauma.
Our results sit in the literature in a unique way, contrasting to what was found by Villavisanis et al. [7] which posited patients that underwent CI with and without labyrinthectomy had comparable outcome to patients without Ménière’s disease. Performance comparison of the labyrinthectomy group was not presented for the purpose of their study, and timing of labyrinthectomy and CI was outside the review’s scope [7]. A meta-analysis by Selleck et al. [12] looking specifically at patients with Ménière’s disease that underwent CI after labyrinthectomy demonstrated a mean postoperative CNC score of 46.5%, which is less than the typically observed CNC performance of 60% seen with traditional CI recipients. In our analysis, the average post-op CNC score was 36.7% for all patients who underwent CI + L compared to 53.1% for patients undergoing CI alone. This difference met statistical significance (p = 0.01). When excluding patients in the CI + L group who had their labyrinthectomy performed in a separate procedure prior to CI, the average post-op CNC score worsened to 30.8%. Looking at the 2 patients who had a CI after labyrinthectomy and available postoperative performance data, one patient demonstrated a CNC score of 66.0%, while the second patient demonstrated 88% on Spanish HINT testing.
Bilateral disease and hearing loss was seen more commonly in the CI-only group, with more CI + L patients having SSD. This could provide an explanation for some performance discrepancy between cohorts, if the patients with SSD and acute vestibular loss were less inclined to utilize their CI with a contralateral functioning ear. The main driver for surgical management of the patients with CI + L was in relation to their vestibular symptoms, with hearing rehabilitation acting as a secondary consideration. This contrasts to the CI-only group, which underwent surgery primarily for hearing restoration. This apparent difference in patient goal prioritization could impact postoperative CI performance. Furthermore, the increased percentage of patients with uncontrolled preoperative vertigo in the CI + L group could also indicate more severe endolymphatic hydrops, which may introduce anatomic and physiologic performance sequelae [7–13]. Further research to better understand provider and patient considerations when deciding upon CI only versus CI + L may provide additional information and potential bias between cohorts that could also impact performance differences.
The timing of labyrinthectomy and CI in this study appeared to influence postoperative speech performance, although an underlying mechanism for this is unclear. The negative impact of an acute vestibular loss, which requires central adaptation, on the ability to also undergo central adaptation to electrical hearing is another consideration, although the 2 patients who underwent chemical labyrinthectomy with gentamycin in our study did not have a statistically significant difference in performance from the remaining CI-only patients (p = 0.59). Unlike a chemical labyrinthectomy, a surgical labyrinthectomy may inherently cause damaging fluid shifts and inflammatory changes within the cochlea which degrades performance and is an interesting area of future study. It is worth noting the performance of the 3 patients in the CI + L group who had a prior labyrinthectomy may represent a biased cohort of patients that had a labyrinthectomy yet did not develop cochlear ossification precluding future implantation. This could indicate that their labyrinthectomy occurred in a less traumatic fashion compared to other patients. The impact of surgical technical factors of labyrinthectomy on performance could also be analyzed further. If CI is considered as a separate procedure following labyrinthectomy, the risk of cochlear ossification and use of a sleeper electrode should be considered.
It should be an expectation that overnight admission will be required if surgical or chemical labyrinthectomy is performed with a CI due to severe vertigo initially experienced following the procedure. Typically, patients were discharged after overnight admission once pharmacologic control of vertigo was achieved, and the balance system begins to recalibrate. All patients undergoing labyrinthectomy did achieve cessation of vertiginous episodes, with only 1 patient going on to develop new vertigo episodes later in life thought secondary to the development of vestibular migraine. Although Ménière’s is rarer in the elderly, consideration of the impact labyrinthectomy may have on this cohort’s balance function, or in patients with bilateral disease, is important. Close conversation with the patient about these risks and benefits of each approach is important and played a role in the 3 patients with uncontrolled preoperative vertigo that underwent CI only, without concurrent labyrinthectomy.
Control of both vertigo and imbalance was achieved in 63% of patients in the CI + L group. The remaining patients (25%) had persistent imbalance of varying severity. In contrast, in the CI-only group, 56% had vertigo cessation, while 38% had persistent vertigo. Of the 3 patients with preoperative uncontrolled vertigo that underwent CI only, 2 patients had persistent vertigo postoperatively, and 1 patient had persistent imbalance. The 1 patient with isolated postoperative imbalance in the CI-only group was previously walker-dependent secondary to known hydrocephalus; thus, their residual deficits are less likely secondary to surgery. These results follow expected mechanisms of each procedure, in which CI alone may result in persistent vertigo episodes from hydrops episodes, while labyrinthectomy removes the input from the balance system on the ipsilateral side to achieve good vertigo control, though it allows for the potential of isolated imbalance sequelae.
Limitations of this study include the small cohorts available for subanalysis, in addition to the prolonged timeline in which patients were followed back to 2010, predating the most updated guidelines on Ménière’s diagnosis. Although mimicking diagnosis such as autoimmune inner ear disease was not deemed to be the primary diagnosis for these patients, it is a possible confounder.
Overall, patients with Ménière’s disease meeting CI candidacy may undergo CI safely and achieve good hearing outcomes. Surgical labyrinthectomy appears to be effective for those with severe vestibular symptoms, though patients often experience acute symptoms in the immediate postoperative period requiring overnight admission. Further research is required; however, patients undergoing simultaneous CI + L may have decreased performance over patients undergoing CI alone. Comparing the speech performance results in a larger cohort of patients that underwent simultaneous surgical or chemical labyrinthectomy with their CI could help determine the role mechanical trauma may contribute to these differences.
Statement of Ethics
Study approval was received by the NYU Langone Health Institutional Review Board (IRB# s23-01394). As part of approval, the study was granted exemption from requiring written informed consent by the NYU Langone Health Institutional Review Board.
Conflict of Interest Statement
Dr. J. Thomas Roland Jr. is a consultant for Cochlear Americas and received research funding for cochlear implant-related projects, which are not affiliated with this research. J. Thomas Roland Jr. and Daniel Jethanamest were members of the journal’s Editorial Board at the time of submission. The remaining authors have no conflicts of interest to declare.
Funding Sources
This study was not supported by any sponsor or funder.
Author Contributions
J.C., D.F., S.M., J.T.R., and D.J. were involved in study development, data analysis, and manuscript preparation. J.C., A.W., and D.J. were involved in data extraction. A.W. was also involved in manuscript preparation.
Funding Statement
This study was not supported by any sponsor or funder.
Data Availability Statement
All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.
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Associated Data
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Data Availability Statement
All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.
