A labyrinthectomy is a surgical procedure of the inner ear performed to address severe, unmanageable vertigo. It involves the permanent destruction of the labyrinth, the complex structure responsible for both hearing and balance. This surgery is considered a last-resort treatment for patients whose debilitating vertigo has not responded to less-invasive treatments. The trade-off is the complete and permanent loss of any residual hearing in the operated ear. By ablating the diseased balance organ, the procedure eliminates the faulty signals, allowing the brain to eventually compensate for the loss of function.
Conditions That Require Labyrinthectomy
A labyrinthectomy is reserved for debilitating conditions where the affected ear has already lost most or all useful hearing function. The most frequent indication is advanced Ménière’s disease, an inner ear disorder characterized by fluctuating hearing loss, tinnitus, aural fullness, and recurring attacks of severe vertigo. This surgery is only pursued when medical management, dietary changes, and less-destructive procedures like intratympanic injections have failed to control the vertigo.
A requirement is that the patient’s hearing in the affected ear must be “non-serviceable,” meaning it is too poor to benefit from a hearing aid. The resulting hearing loss is an acceptable consequence for gaining relief from incapacitating vertigo. While Ménière’s disease is the most common cause, the procedure may also be considered for other non-responsive inner ear disorders. These include severe, unstable vestibulopathy following labyrinthitis (an inner ear infection) or severe benign paroxysmal positional vertigo (BPPV) that cannot be corrected by repositioning maneuvers.
How the Surgery is Performed
Labyrinthectomy is performed under general anesthesia with the objective of permanently eliminating the neurosensory receptors that generate balance signals. The surgeon targets the neuroepithelium within the semicircular canals and the vestibule, which are the parts of the inner ear responsible for sensing movement and spatial orientation. By destroying these sensory elements, the procedure stops the transmission of abnormal signals to the brain, effectively silencing the diseased inner ear.
There are two primary surgical methods used to access the labyrinth. The transcanal approach is the less invasive method, where the surgeon enters the inner ear through the ear canal, often requiring stapes bone removal. While quicker, this approach carries a higher risk of incomplete removal of the labyrinthine neuroepithelium.
The transmastoid approach is the most effective and thorough method for complete ablation. This technique requires the surgeon to perform a mastoidectomy, drilling through the mastoid bone behind the ear to gain direct access to the inner ear structures. Once the bony labyrinth is exposed, the semicircular canals and vestibule are opened, and the neurosensory epithelia are surgically excised under direct visualization. This extensive removal ensures the complete destruction of the faulty balance mechanism.
Recovery and Vestibular Compensation
Immediately following a labyrinthectomy, the patient experiences severe imbalance, nausea, and vertigo, as the brain suddenly loses all input from the operated ear. This acute stage, caused by the profound imbalance between the healthy and ablated ears, requires an inpatient hospital stay, typically lasting one to three days, for monitoring and management with anti-nausea medications. The initial unsteadiness is significant, and patients often require assistance, such as a cane or walker, to move safely upon discharge.
The long-term success of the procedure relies on vestibular compensation, the brain’s ability to adapt to the permanent loss of one balance organ. The brain learns to suppress unreliable signals from the operated ear and relies solely on input from the remaining healthy ear, visual cues, and proprioception (the body’s sense of position and movement). This central adaptation converts an unstable, unpredictable vestibular problem into a stable, manageable one.
Vestibular Rehabilitation Therapy (VRT) accelerates the compensation process. Specialized physical therapists guide the patient through targeted exercises that challenge the balance system, encouraging the brain to integrate the remaining sensory information. The surgery is highly effective at eliminating episodic vertigo attacks, with success rates often reported between 95 and 100 percent. However, some patients may experience mild, residual disequilibrium, which is often more noticeable in challenging environments, such as walking on uneven terrain or navigating in the dark.