Endolymphatic Sac Surgery for Ménière's Disease – Current Opinion and Literature Review

Abstract

Introduction The endolymphatic sac is thought to maintain the hydrostatic pressure and endolymph homeostasis for the inner ear, and its dysfunction may contribute to the pathophysiology of Ménière's disease. Throughout the years, different surgical procedures for intractable vertigo secondary to Ménière's disease have been described, and though many authors consider these procedures as effective, there are some who question its long-term efficacy and even those who think that vertigo control is achieved more due to a placebo effect than because of the procedure itself. Objective To review the different surgical procedures performed in the endolymphatic sac for the treatment of Ménière's disease. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis We focus on describing the different surgical procedures performed in the endolymphatic sac, such as endolymphatic sac decompression, endolymphatic sac enhancement, endolymphatic sac shunting and endolymphatic duct blockage, their pitfalls and advantages, their results in vertigo control and the complication rates. The senior author also describes his experience after 30 years of performing endolymphatic sac surgery. Conclusions The endolymphatic sac surgery, with all its variants, is a good option for patients with incapacitating endolymphatic hydrops, providing a high percentage of vertigo control and hearing preservation.

Current Understanding and Clinical Management of Meniere's Disease: A Systematic Review

“…While these techniques are considered nondestructive procedures as they preserve the auditory function, transmastoid labyrinthectomy is completely destructive to the labyrinth and is indicated only in patients with established nonserviceable hearing loss and persistent recurrent vertigo attacks. [106][107][108][109][110][111][112] -Vestibular rehabilitation: It could be proposed in patients with MD with an established vestibular deficit to facilitate vestibular compensation. However, in the initial years of the disease, its usefulness is controversial.…”

Vestibular and audiometric results after endolymphatic mastoid shunt surgery in patients with Menière’s disease

“…Moreover, the study at hand depicts detailed pre- and postoperative audiometric and vestibular results showing the safety of this non-destructive treatment option for MD patients. All patients received the same type of endolymphatic sac surgery—a endolymphatic mastoid shunt with application of a triangular silicone foil which seems to be the most common technique according to the literature [ 28 – 30 ] (Table 4 ). The most crucial novel aspect of the study at hand is the comparison of results between both study subgroups: patients who seem to have benefitted from the procedure and those who have not.…”

The History of Otology and What We Can Learn from It: Putting Historical Research in Context

“…Other interventions for MD like endolymphatic sac surgery were developed around the same time and are still offered to patients. Many case series by prominent otologic surgeons have shown excellent rates of improvement in vertigo and described variations of this technique (8). In 1981, however, one of the few placebo-surgery controlled double-blind studies in the medical literature by Thomsen et al showed reductions in symptoms (even after re-examination 3 years after surgery) (9) in all patients, regardless of whether they underwent endolymphatic sac decompression or shunting versus simple mastoidectomy (10).…”