Imaging meets function: radiological and vestibular predictors of long-term cochlear implant outcomes in patients with Ménière disease.

INTRODUCTION: Although the proportion of Ménière disease (MD) patients who meet candidacy for CI remains relatively low, this subgroup has garnered increasing clinical interest. The main objective of this work is to evaluate the influence of preoperative vestibular function and radiological markers of endolymphatic hydrops (EH) on long-term auditory outcomes after cochlear implantation (CI) in patients with definite Ménière’s disease (MD). METHODS: All patients underwent CI and were assessed using a dedicated 3T MRI hydrops protocol. Audiological outcomes were measured using pure-tone audiometry (PTA) and speech recognition scores (SRS) at 65 dB, with a follow-up of up to five years. Preoperative vestibular assessment included video head impulse testing (vHIT), cervical and ocular vestibular evoked myogenic potentials (cVEMP, oVEMP), and caloric testing. MRI analysis evaluated cochlear and vestibular EH, perilymphatic enhancement, endolymphatic herniation (EHern), and the vestibular endolymphatic volume ratio (REL). RESULTS: The 41 patients who underwent CI surgery resulted in significant and sustained improvements in PTA and SRS over five years (p < 0.001). Cochlear EH was associated with worse preoperative PTA but not with long-term speech outcomes. Patients undergoing simultaneous labyrinthectomy showed significant auditory gains but poorer five-year PTA compared with CI alone (p = 0.009). Abnormal cVEMP responses were associated with lower five-year SRS (p = 0.019). Higher REL correlated with poorer SRS at 65 dB (r = − 0.357, p = 0.039). CONCLUSION: CI provides durable auditory benefits in patients with definite MD. Preoperative vestibular integrity, particularly cVEMP responses and vestibular endolymphatic volume, contributes to long-term speech recognition outcomes.