Selective cochlear neurotomy in the cerebellopontine cistern using electrophysiological monitoring in a patient with intractable tinnitus. Case report.

Selective cochlear neurotomy for intractable tinnitus is quite difficult to perform because there is no way to approach the cochlear nerve without interfering with other neural structures. The authors successfully performed selective cochlear neurotomy in the cerebellopontine cistern in a patient with persistent intractable high-pitched tinnitus, but with normal hearing and vestibular functions, by monitoring cochlear nerve compound action potentials and auditory brainstem responses. The procedure is a very simple and safe technique for the treatment of intractable tinnitus. Although this destructive procedure is the last choice of treatment, it can be justified in patients who have poor hearing and severe tinnitus in spite of normal vestibular functions. The procedure may also be applied in some rare cases such as that of the present patient whose quality of life was markedly reduced because loud tinnitus prevented him from hearing anything with the affected ear even though his hearing and vestibular functions were normal.