Cochlear implants have been widely used in patients with severe to profound sensorineural deafness, either congenital or acquired, bilaterally, with satisfactory results in hearing recovery. Theoretically, bilateral Ménière’s disease progressing to severe or profound sensorineural deafness, or unilateral Ménière’s disease with contralateral profound sensorineural deafness due to a different etiology, should be an indication for cochlear implantation. However, because Ménière’s disease has symptoms such as episodic vertigo, fluctuating progressive hearing loss, stuffiness in the ear, and varying degrees of tinnitus, cochlear implantation must not only address the issue of hearing restoration, but must also take into account the restoration of vestibular function, especially vertigo, and the clinical incidence of bilateral severe Ménière’s disease with bilateral profound sensorineural deafness is low. Therefore, cochlear implantation for bilateral severe sensorineural deafness due to Ménière’s disease has not been reported in the literature in China, and only a few cases have been reported abroad. In this paper, we present a case of cochlear implantation in a patient with bilateral profound sensorineural deafness caused by Ménière’s disease, and discuss the indications for cochlear implantation in Ménière’s disease and the preoperative and postoperative management. 1. Clinical data The surgical case was an inpatient of the Department of Otolaryngology, Second Affiliated Hospital of Sun Yat-sen University in March 2006, a 31-year-old female who started to have episodes of vertigo with no obvious cause 15 years ago, each episode lasting from about 30 minutes to several hours, with tinnitus, increased ear congestion, nausea and vomiting, etc. During the episodes, the hearing in both ears fluctuated and decreased with the increase of the number of episodes, and was diagnosed in a foreign hospital as “He was diagnosed as “bilateral Ménière’s disease” in a foreign hospital, and the effect of conservative drug treatment was poor. For the past 2 years, her speech has been declining, and she can only communicate briefly with acquaintances by combining lip reading, and she has not had any vertigo attacks for 1 year. Pure tone audiometry showed that the hearing threshold was above 100dB, and the left side was worse than the right side; the speech recognition rate was 35% with hearing aids in a quiet environment; ABR: 100dB bilaterally did not lead to any waveform; otoacoustic emission: bilateral did not pass, cochlear lesion was considered; video nystagmography: no abnormalities in the optokinetic center test, cold and hot dual temperature test suggested that the left side The vestibular function was 77% reduced unilaterally, and the dominant bias was 39% to the right, suggesting that the left hemianopsia was reduced, and the lesion involved the left elliptical sac. High-resolution CT of the temporal bone and MRI of the internal auditory tract were normal, and the cochlea and cochlear nerve were well developed. The diagnosis was “bilateral profound sensorineural deafness due to Ménière’s disease”. The cochlear implantation was performed under general anesthesia. The cochlear implantation was performed through the facial nerve saphenous approach, and the cochlea was entered by grinding open the bulb above the round window niche. The 12 pairs of electrodes of the Austrian cochlear implantation The cochlear implantation of the 12 pairs of Austrian cochlear implants Medel Comtex 40+ was completed at the drill hole. There were no immediate postoperative complications such as facial paralysis or vertigo. The patient started to experience vertigo and vomiting on the first postoperative day, and the symptoms subsided after symptomatic treatment. Bilateral tinnitus was the same as before surgery and did not worsen. The wound was removed 1 week after surgery, and the oblique sagittal position of the cochlea was reexamined, and 12 pairs of electrodes were completely located in the cochlea with normal position and shape. When the cochlear implant was turned on one month after surgery, the sound field test reached 30dB on the left side, and the speech recognition rate of closed bisyllabic words in a quiet environment was 70%; there was no induced vertigo or tinnitus when the cochlear implant was turned on. 2. Discussion The selection criteria for the indication of cochlear implantation are for severe or very severe deafness in both ears, and the lesion is localized and diagnosed in the cochlea. The indications for cochlear implantation in Ménière’s disease include bilateral end-stage Ménière’s disease, or bilateral severe to profound profound sensorineural deafness due to unilateral Ménière’s disease in patients with contralateral profound to profound sensorineural deafness due to a different etiology. Seven cases had bilateral Ménière’s disease causing bilateral profound sensorineural deafness, one case had unilateral profound sensorineural deafness caused by meningitis at the age of 2 years and Ménière’s disease in the other ear as an adult, and one case had Ménière’s disease in the contralateral ear 20 years after surgical removal of a vestibular neuroma on one side. The average duration of Ménière’s disease before cochlear implantation lasted 27 years (10-41 years). Five cases had endolymphatic sac decompression or shunt, one case had exolymphatic fistula exploration, and one case had vagotomy to control vertigo attacks. None of the cases received preoperative intra-drum gentamicin injection. One case of postoperative complications was due to thin flap necrosis, one case required readmission one week after surgery due to severe vertigo, and one case required second implantation due to implant problems. The follow-up period was 1 to 5 years. This patient had a 15-year history of cochlear implantation in our department. He had developed severe sensorineuralism bilaterally, had poor results with high-powered hearing aids, had low speech recognition rate, and had begun to lose his speech ability with slurred speech in the past 2 years. The patient has been free of vertigo episodes for the past 1 year and, according to Lawrence R, vertigo episodes are rare after cochlear implantation in end-stage Ménière’s disease patients who have been free of vertigo episodes for 1 year; in addition, the patient strongly requested improved hearing and all laboratory tests were consistent with the indications for cochlear implantation. Pasanisi E concluded that there was no significant difference in hearing and speech recognition rates between cochlear implants for Ménière’s disease and adult postlingual deafness at 6 months postoperatively, and that the former improved significantly at 1 year postoperatively and gradually with longer follow-up. This difference was thought to be due to the fact that Ménière’s disease patients have better residual hearing than adults with post-verbal deafness. However, a subsequent study found no significant difference in sentence recognition rates between the two patients before surgery. However, due to the small number of cochlear implant cases in Ménière’s disease, the exact relationship between hearing recovery and speech recognition rates after cochlear implantation and other etiologies of adult postlingual deafness remains to be further investigated. In order to reduce the number of postoperative vertigo attacks, it is advisable to control vertigo symptoms before cochlear implantation. Only one case had a history of vertigo episodes 1 year before surgery and 3 episodes in the first 3 months after surgery, but no vertigo episodes in the next 4.5 years. In our case, there was no vertigo attack one year before surgery, and no intra-dural injection of gentamicin, endolymphatic sac decompression, or vagotomy was performed, and only a transient vertigo occurred on the first day after surgery. Thus, if the patient had end-stage Ménière’s disease before the cochlear implantation and had no vertigo for 1 year before the implantation, the vertigo will rarely appear again clinically, and even if it appears, it is mostly transient and rarely occurs continuously and repeatedly; if the patient still has vertigo for 1 year before the implantation, endolymphatic sac decompression, chemical vagotomy and vestibular nerve dissection can be performed before or during the cochlear implantation to control the vertigo. Morgan M et al. reported that a patient with severe vertigo and sensorineural deafness diagnosed with Ménière’s disease who underwent chemical vagotomy followed by cochlear implantation showed significant recovery of hearing and reduction of vertigo. Adair RA [4] used a modified chemical vagotomy method – direct infusion of streptomycin into the posterior semicircular canal – to treat Ménière’s disease, which allowed the drug to act directly on the vagus with less impact on the cochlea, and found not only better control of the vertigo symptoms of Ménière’s disease, but also maximum preservation of hearing and fewer complications. This modified method achieved 94% control of vertigo symptoms and 55% hearing preservation in Ménière’s disease, respectively. Ovid Zwolan also reported a case of a 47-year-old woman with delayed vagal effusion with severe to very severe sensorineural deafness bilaterally detected at birth due to maternal viral infection, followed by episodes of vertigo, tinnitus, and stuffiness in the ear. neurological deafness, 88% attenuation on the right side of the single test on cold and heat, and 41% predominance bias to the left. The right vagotomy was performed, the vestibule was filled with myofibrous tissue, and then the right cochlear implant was performed. Kemink and Schuknecht HF [7] found that patients with prior vagotomy had a positive response to electrical stimulation in the cochlear implant, which demonstrated that vagotomy did not affect the peripheral auditory response. This demonstrates that vagotomy does not affect the peripheral auditory response. This series of findings suggests that vasectomy for vertigo control followed by cochlear implantation is feasible in patients with Ménière’s disease, and that preoperative chemical disruption and vasectomy are not contraindications to surgery.