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Deciding between labyrinthectomy and gentamicin

Discussion in 'Your Living Room' started by Clare, Jul 14, 2018.

  1. Clare

    Clare Active Member

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    After 17 years of vertigo persisting through the usual medical treatments, I’ve come to the point of choosing between gent injections or labyrinthectomy, and I’ve surprised myself. Until recently it seemed obvious that the lower risk and reduced pain of a non-surgical approach would clearly be more sensible. But now I’m leaning toward choosing labyrinthectomy.

    My left side hearing loss is between severe and profound, and word recognition is 0 – 2%. After a particular hellish first half of 2018 involving over 50 full-spinning attacks, two separate doctors have concluded it’s appropriate to consider destructive treatment.

    In a nutshell, the neurotologist laid it out this way:
    Gentamicin – 80% of patients helped in 1-2 injections. 5% risk of prolonged imbalance. Office procedure. Get one injection, wait 6 weeks and if vertigo recurs, get another injection and see what happens. Will be sick at first, then improve with vestibular therapy.

    Labyrinthectomy – 95% effective. 4% risk of spinal fluid leak, which would be treated with another surgery. 1% risk of Bell’s palsy (partial facial paralysis) that may last a few months or could be permanent. 2-3 days in hospital, then a week of sickness where help at home is needed; 3 months to recovery (with vestibular therapy) and being able to drive again.

    I imagined my future under each scenario. Surprising to me, I am realizing that reclaiming my life from the MM beast means not just stopping the vertigo but also restoring my confidence and living without fear. It is the anxiety of when the next attack might occur that has diminished my life at least as much as the temporary bouts of vertigo. Vertigo is temporarily disabling, while anxiety makes a constant hit on quality of life.

    I did a search for articles that compare quality of life improvement measures after gentamicin and labyrinthectomy and didn’t find much research on it. There is plenty written about stopping vertigo, but I couldn’t find anything that took a broader definition of “success” to include overall quality of life improvement. If anyone knows of such a study or posts along this line, please let me know.

    It seems to me that gentamicin injections would eventually treat the vertigo over some amount of time, but anxiety would linger on, still waiting for an attack that may or may not come. The labyrinthectomy, however, would be final on a specific date, and I could be free from the anxiety and reclaim my life going forward. Visualizing both approaches in this way is tipping me into the laby camp.

    I’m curious to hear thoughts from others about making this decision.
     
  2. Mac

    Mac Active Member

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    I’ve battled it for 11 years. I’m 39. You name it...I’ve done it including surgeries. If I was over 50 I’d get the labby in 2 seconds.
    I’d be closer to retirement. My kids would be in HS/college. For me it’s my age that holds me back.

    Good luck with your decision. 50 attacks this year. That’s hell. Fingers crossed whatever you choose is s huge success.
     
  3. PleaseNoDizzy

    PleaseNoDizzy Active Member

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    I have to be brief as I’m sitting on an airplane waiting to take off. Getting a labyrinthectomy this week. My dr gave me the option of gent but said there’s a significant likelihood I’m putting off the i evnevitsble and would end up with a labyrinthectomy anyway. I’m 44 and have been dealing w this for 7 years. I haven’t driven in months due to the uptick in attacks. I have 3 kids ages 6-15 and they all need mom well. I’m ready to be DONE.probably naive but I’m not too concerned about the potential complications. I’m very nervous about the recovery process but it seems to be the only way to the “other side”. Recent tests show my good ear is 100% fine but I still worry about little pings and pangs in there, as well as occasional tinnitus. I still worry but at this point am not all that functional so going to take the leap. Have to run...
     
  4. PleaseNoDizzy

    PleaseNoDizzy Active Member

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    And plane is delayed again :D wanted to add that the anxiety component that you mention is completely true in my case too. Never knowing what’s right around the corner. Can I drive my son to his practice safely? Can I walk Fhe dog around three neijbirhood and not get stranded a block away (happened recsenrly)? Can I buy tickets for a show with my husband that’s happening two months from now and be able to go? We’ve had to change a lot of plans — first world problems, I know — as a result of my illness. Trips cancelled, kids performances I’ve missed, you name it.

    Ok now maybe we are taking off...
     
  5. June-

    June- Well-Known Member

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    Just curious, why does age make you not get a laby?
     
  6. PleaseNoDizzy

    PleaseNoDizzy Active Member

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    Wow sorry for all the typos up there ^^^. Was typing so quick thinking I’d have to shut off phone at any moment.
     
  7. Mac

    Mac Active Member

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    If I live to 80...40 years with one ear is a long haul. I already have some hereditary hearing loss in my good ear. All of my older relatives wear hearing aids. So I do consider she heavily in my decision. If was 60 it would be a no brainer.

    But also if I had 50 attacks since Jan 1 like Clare I’d do it tomorrow at 25. That’s awful. Feel bad for her. Hope it works out.
     
  8. June-

    June- Well-Known Member

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    I have had one ear since 1997, since i was 49. I dont give it a thought on an average day. I do wish i could echolocate though. But i dont work in a train yard or anything so it is not a big deal. My surgery was not optional and it was thought i would retain hearing so i didnt have to weigh the options like you do.

    If you do have a laby have a discussion with your dr about whether you will still be able to have a cochlear implant down the road if the need should arise.
     
  9. PleaseNoDizzy

    PleaseNoDizzy Active Member

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    Mac have you considered a BAHA? I’m getting one this week.
     
  10. Mac

    Mac Active Member

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    That's awesome...I know you have been going through hell. I hope this surgery allows you to get back to a normal life. I know how hard it is with young kids!!

    I would probably go with just one ear first...and see how it goes. My cousin is deaf in one ear from Meniere's. She wears cross overs hearing aids (started wearing them around age 45) and swears by them. So I would give that a shot first I think. But I am sure the Baha is great!!

    Good luck!!!
     
  11. Clare

    Clare Active Member

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    Mac, a previous doctor had raised concerns about bilateral involvement, but because of several technical errors, the test results were flawed. For multiple reasons, I had lost confidence in the care I was getting. Thankfully, I went to Mayo for a second opinion, where the tests were repeated and it was determined that there is no bilateral involvement at this time. Mayo's approach was a world of difference, and I will be continuing my care there.

    June, I did ask the surgeon about possible future cochlear implant, and the laby surgery should not affect that. I have not discussed BAHA with anyone. CROS hearing aids have not been helpful. I agree with you that the inability to locate sound is perhaps the most frustrating part of being one-sided.

    PleaseNoDizzy, best of luck to you this week!!! The laby recovery process does sound a little off-putting, but the prospect of no more vertigo attacks is the very bright light at the end of that tunnel. Reading the posts here of those who have gone through the recovery process and reclaimed their lives is so encouraging. I hope the same for you. It's great that you are doing BAHA at the same time; I will have to ask about that. I don't think my insurance would cover it, though.
     
  12. June-

    June- Well-Known Member

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    Cros aids were not helpful to me either. I am not sure if i just didnt put the effort into it, i dont wear bifocals either, or the fault is the aid but i have had two sets over the years which both ended up in the garbage. A lot of money for noth8ng for me. Maybe different for someone else.
     
  13. redwing1951

    redwing1951 Well-Known Member

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    Clare, I had one gent shot before deciding on the laby. If I had to do it over again I would not have the gent shot. The shot gave me some relief for about 8 months. Gent stopped the violent vertigo but everyday I was light headed and somewhat dizzy. My gait was off, stumbling around like a drunken sailor. And still having that horrible monkey on my back, wondering when the next drop attack would occur. So this is my 2 cents worth. Skip the gent and go for the laby. I had one overnight in the hospital. Walked out of the hospital on my own. Was driving after 2 weeks. The quickest way back to being normal is walking each and every day as much as you can. Walk on different terrain. The more you walk the sooner your brain will compensate for unilateral vestibular system.

    What ever you decide I wish you the very best going forward. I lived with the beast for 12 hellish years. My life returned to normal 5 years ago. I have never regretted my decision.
     
    • Informative Informative x 1
  14. Clare

    Clare Active Member

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    Thanks for sharing your experience, Redwing. It's really helpful to hear.
     
  15. James

    James ''Everywhere I go there I am'' GS

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    Clare, Whatever you decide I wish you the best. As others have said the Laby seems to do the trick for a lot of people. I know you have probably searched the archives but there are a lot of positive results.Good to know you can still get a Cochlear if you need it.Mayo sounds great.Good luck keep us posted!

    PleaseNoDizzy-Good luck with yours as well. We are all rooting for both of you!
     
  16. Stacbird

    Stacbird Member

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    Good luck with your decision. The Laby will free you from the beast! I had mine at age 49.
     
  17. Baloo

    Baloo Member

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    Hello clare

    I look at the forum regularly but dont post often because of dealing with a lot of issues at work (bullying). I have had gent injections and it stopped the really bad vertigo attacks that made me very sick. I do feel off balance and light headed a lot of the time but I am hoping that vestibular rehab will help with that. I wanted to let you know there is a newer steroid treatment

    https://www.imperial.ac.uk/news/175995/severe-dizziness-treated-with-steroid-injections/

    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31461-1/fulltext?code=lancet-site

    I have also had this and it has helped me. In the Uk where I am this new treatment is offered instead of gentamicin. Its not 100% so there are no guarantees but I just wanted to let you know about it.

    baloo
     
  18. Clare

    Clare Active Member

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    Thanks for the links, Baloo. It's good to hear about published trials of new treatments. Perhaps this steroid will help more people to quell the vertigo while protecting their hearing.

    I hope your work situation gets better.
     
  19. Clare

    Clare Active Member

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    I have scheduled labyrinthectomy surgery for August 23, and I'm pretty damn excited about it. Yes, dreading the recovery, but totally focused on a life without fear afterward!
     
  20. Pupper

    Pupper Active Member

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    Gutsy call. I think you're doing right by your self.
     

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