A comparison of endolymphatic duct blockage, endolymphatic sac drainage and endolymphatic sac decompression surgery in reversing endolymphatic hydrops in Meniere's disease

Abstract

Background To explore the differences between endolymphatic duct blockage, endolymphatic sac drainage and endolymphatic sac decompression surgery in the reversal of endolymphatic hydrops (EH) in patients with intractable Meniere’s disease (MD). Methods A total of 27 MD patients receiving endolymphatic duct blockage surgery (n = 10), endolymphatic sac drainage surgery (n = 9) and endolymphatic sac decompression surgery (n = 8) underwent gadolinium-enhanced inner ear magnetic resonance imaging (MRI) scans prior to, 2 weeks after and at > 12 months following surgery. Results In the group with endolymphatic duct blockage, the second MRI revealed no changes in EH, whereas the third MRI revealed a reversal of vestibular EH in 3 patients and a downgrading of cochlear hydrops in 2 of these 3 patients, who presented with an improvement in their hearing and complete control of vertigo. In the group with endolymphatic sac drainage, the second MRI showed a reversal of EH in 4 patients, and no changes in EH in the remaining 5 patients, whereas the third MRI showed that those 4 patients who presented with a reversal of EH at the second MRI stage remained unchanged except a recurrence of vestibular hydrops in 1 patient. All 4 patients exhibited a complete control of vertigo, but hearing improved in 1, worsened in 1 and remained unchanged in 2. In the group with endolymphatic sac decompression, both the second and third MRI examination revealed no reversal of EH. Conclusions The present study has shown that both endolymphatic duct blockage surgery and endolymphatic sac drainage surgery have the potential to reduce EH in certain MD patients, but none of the patients receiving endolymphatic sac decompression surgery showed reversal of their EH. Graphical Abstract

Meniere's Disease Patients with Distinct Sac Pathoanatomic Findings React Differently to Endolymphatic Duct Blockage

“…Based on the fact that the intact iES epithelium is as same as that of control cases in the patients with degenerative and hypoplastic eES pathology, 16 the ES drainage surgery, by incising the ES lumen from the eES to the distal iES, may be an alternative treatment option for releasing the surplus of endolymph in the inner ear in these patients. The result in our previous study has shown the EH in these MD patients with atrophic eES also could be reversed following this modified ES drainage surgery 36 . Therefore, based on the different pathogenesis of the production of EH, a personalized treatment should be considered in these two subgroups of MD patients with normoplastic eES and atrophic eES.…”

“…The result in our previous study has shown the EH in these MD patients with atrophic eES also could be reversed following this modified ES drainage surgery. 36 Therefore, based on the different pathogenesis of the production of EH, a personalized treatment should be considered in these two subgroups of MD patients with normoplastic eES and atrophic eES. Figure 7 lays out a working drawing for EDB surgery on patients with normoplastic eES and ES drainage surgery on patients with atrophic eES.…”

The effect of vascular risk factors on the efficacy of endolymphatic sac decompression surgery for Meniere’s disease: a retrospective cohort study

“…This may be attributed to the fact that the operation alleviates the rapid expansion of membranous labyrinthine hydrops rather than cures it. Notably, the membranous labyrinthine hydrops caused by vascular risk factors or other causes persists after surgery ( 30 ). The operation just prevents further aggravation of the condition owing to arteriovenous mixing, which may result from endolymphatic sac vessel reflux to the inner ear due to excessive pressure ( 31 ).…”

A Comparison of Local Endolymphatic Sac Decompression, Endolymphatic Mastoid Shunt, and Wide Endolymphatic Sac Decompression in the Treatment of Intractable Meniere's Disease: A Short-Term Follow-Up Investigation

“…However, Paparella ( 29 ) proposed that endolymphatic sac surgery is likely to enhance the blood supply of the sac and improves its absorption function such that alleviates endolymphatic hydrops. A recent study compared the changes of endolymphatic hydrops after different surgeries through enhanced MRI ( 30 ). The results showed that endolymphatic hydrops was improved in some patients after ESMS and endolymphatic duct blockage surgery but not in those patients with ESD surgery ( 30 ).…”

“…A recent study compared the changes of endolymphatic hydrops after different surgeries through enhanced MRI ( 30 ). The results showed that endolymphatic hydrops was improved in some patients after ESMS and endolymphatic duct blockage surgery but not in those patients with ESD surgery ( 30 ). Taking all these into account, therefore, we suggest that the possible reasons for the better outcome of WESD for intractable MD are as follows: ( 1 ) extensive decompression of the endolymphatic sac and dura is supposed to reduce the local impact of granulation tissue, fibrous tissue proliferation, and new bone formation on the endolymphatic sac after surgery; ( 2 ) the local hydrostatic pressure and osmotic pressure are changed; ( 3 ) extensive decompression affects the blood supply of the endolymphatic sac, resulting in the alteration of the endolymphatic sac activity; and ( 4 ) reduced secretion of glycoprotein, in turn, reduced endolymph influx to the endolymphatic sac such that relieve an attack of vertigo.…”