Learning objectives:

1. 1. Understand the challenges in managing intractable vertigo in Ménière's disease.

2. 2. Review the literature on cochlear implantation outcomes in Ménière's disease.

3. 3. Learn about simultaneous labyrinthectomy and cochlear implantation as an emerging technique in the management of Ménière's patients with intractable vertigo.

Introduction: Patients with Ménière's disease can develop unaidable sensorineural hearing loss. Cochlear implantation has recently been utilised in this group with favourable outcomes. A more challenging group are those with intractable vertigo and they have traditionally posed a significant management dilemma.

Methods: Retrospective case note review was performed in a tertiary referral centre. Three female patients with recurrent incapacitating attacks of vertigo despite conservative management underwent simultaneous labyrinthectomy and cochlear implantation. Two patients had unaidable hearing preoperatively. One patient had moderate-severe sensorineural loss and was suffering from frequent debilitating drop attacks that had resulted in injury.

Results: There was complete resolution of vertigo in all patients in our series. Speech perception in quiet and ability to hear in background noise improved in all cases. Review of the literature demonstrated a small number of cases worldwide in whom simultaneous labyrinthectomy and cochlear implantation have been performed with successful outcomes.

Conclusion: Surgical labyrinthectomy is an effective method for elimination of vertigo in patients with Ménière's disease. The major disadvantage in the past was loss of residual hearing. Cochlear implantation is now an option in these patients. The benefits of simultaneous labyrinthectomy with cochlear implantation include prevention of implantation of a fibrosed or ossified cochlea, a decrease in the duration of deafness and a single operative procedure. This technique should be considered as a management option in carefully selected patients.