Name of the Procedure:

Labyrinthectomy; with mastoidectomy

Summary

A labyrinthectomy with mastoidectomy is a surgical procedure that involves the removal of the labyrinth (a part of the inner ear) along with portions of the mastoid bone behind the ear. This surgery is performed to address severe inner ear problems that lead to debilitating vertigo and balance issues.

Purpose

The primary goal of this procedure is to eliminate vertigo by removing the affected parts of the inner ear responsible for balance disorders. It often results in significant relief from balance problems and dizziness, improving the patient's quality of life.

Indications

• Severe, intractable vertigo
• Ménière's disease unresponsive to other treatments
• Persistent balance disorders adversely impacting daily activities
• Patients with unilateral symptoms where one ear is significantly affected

Preparation

• Patients may be advised to fast for several hours before surgery.
• Adjustment or discontinuation of certain medications may be required.
• Comprehensive pre-operative assessments, including audiometric tests and imaging studies (CT or MRI scans), are conducted to evaluate the extent of the ear disorder.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made behind the ear to expose the mastoid bone.
3. Using a high-speed drill, the surgeon removes part of the mastoid bone to access the inner ear.
4. The labyrinth, including the semicircular canals, is carefully removed to eliminate the balance organs.
5. The area is meticulously checked for bleeding and sealed.
6. The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure generally takes between 3 to 4 hours.

Setting

This surgery is typically performed in a hospital operating room under sterile conditions.

Personnel

• ENT (Ear, Nose, and Throat) Surgeon or Neurotologist
• Anesthesiologist
• Surgical Nurse
• Operating Room Technician

Risks and Complications

• Hearing loss in the operated ear (usually deliberate to relieve symptoms)
• Facial nerve injury leading to weakness or paralysis
• Cerebrospinal fluid leak
• Wound infection
• Persistent dizziness or imbalance
• Risks related to general anesthesia

Benefits

• Significant reduction or complete elimination of vertigo.
• Improved balance and quality of life.
• Relief from the debilitating effects of inner ear disorders.

Recovery

• Hospital stay for 1 to 2 days post-surgery for monitoring.
• Initial dizziness or imbalance expected as the brain adjusts.
• Pain management with prescribed medications.
• Avoidance of strenuous activities and complete rest for the first few weeks.
• Outpatient follow-up appointments for wound assessment and balance rehabilitation therapy.

Alternatives

• Non-surgical treatments such as medications, vestibular rehabilitation therapy, or intratympanic steroid injections.
• Endolymphatic sac decompression surgery.
• Pros: Less invasive, fewer risks associated with general anesthesia.
• Cons: May be less effective for severe cases of vertigo or balance disorders.

Patient Experience

During the procedure, the patient will be under general anesthesia and will remain unconscious and pain-free. Post-operatively, the patient may experience mild to moderate pain at the surgical site, managed by medications. There can be temporary dizziness and imbalance as the brain compensates for the loss of balance organs, but with time and rehabilitation, these symptoms typically improve.