Cochleosacculotomy

Abstract

Schuknecht introduced the cochleosacculotomy procedure in 1982. This procedure has an advantage in that it can be done with a local anesthesic. The idea is to create a permanent fistula between the endolymph and perilymph. The fistula is created by introducing a 3 mm right-angle pick through the round-window membrane, thus rupturing the cochlear duct and osseous spiral lamina. The procedure is safe and rapid, with minimal postoperative morbidity. Its success rate in curing vertigo was 70% during a 6-month follow-up period. The main drawback is that the surgeon cannot visualize the area of the fistula. One week after the procedure, 8 of 14 patients had a sensorineural hearing loss of greater than 15 dB (pure-tone average [PTA]), and 11 of 14 had a loss of speech discrimination greater than 15%. In the next 1 to 3 months postoperatively, hearing generally improved, so that 3 of 10 had a 15 dB (PTA) loss and 8 of 10 had a loss of speech discrimination greater than 15%. At this time follow-up has been too short to determine long-term effects and results. Early results, however, indicate that this procedure may have value in selected patients with Meniere's disease when hearing preservation is not of great concern.