Reddy P, Yan F, Liu YF, et al. - For retaining hearing after an inner-ear operation, preservation of endolymphatic fluids, maintenance of a fluid-filled vestibule, and preservation of the cochlear nerve and its vasculature, are assumed as essential. However, there are some studies reporting no hearing loss despite the violation of the vestibule which led researchers to investigate if disruption of the vestibule of the inner ear always lead to hearing loss. They searched PubMed, Scopus, Ovid, and Cochrane Library databases adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines and identified 10 studies with 10 cases in whom surgical removal of cholesteatoma or vestibular schwannoma was performed and postoperative hearing preservation was attained. In addition, this study reported on 1 patient with Meniere disease who underwent complete labyrinthectomy and had retained hearing following the procedure. Findings seemed contradicting the principle that preservation of a fluid-filled vestibule is essential to hearing preservation and suggest that an occlusion of the ductus reuniens with granulation tissue or bone dust may be enough for preserving hearing after labyrinthine destruction.