A comparison of endolymphatic shunt surgery and intratympanic gentamicin for meniere's disease

Abstract

Objective To report audiovestibular outcomes following endolymphatic shunt surgery (ELS) and intratympanic gentamicin injections (ITG) in patients with Meniere's disease (MD). Study Design Retrospective matched cohort study Methods Patients with MD refractory to medical management between 2004 and 2017 were reviewed: 44 patients underwent ELS and had outcomes available, while 27 patients underwent ITG and had outcomes available. Mean follow‐up durations for the ELS and ITG groups were 39.1 and 43.3 months, respectively. Twenty‐six patients from the ELS group and 24 patients from the ITG group were then included in a pretreatment hearing‐ and age‐matched analysis. Main outcome measures were successful control of vertigo, pure‐tone average (PTA; 0.5, 1, 2 and 4 kHz), word recognition score (WRS), and treatment complications. Results A matched analysis showed vertigo control rates of 73.1% in the ELS group and 66.8% in the ITG group, which were not significantly different (P = .760). The change in PTA following treatment was statistically similar between the ELS group (6.2 dB) and ITG group (4.6 dB) (P = .521), while the change in WRS for the ELS group (+3.9 %) was significantly more favorable than the ITG group (‐13.6 %) (P = .046). Chronic post‐treatment unsteadiness was reported in 25.0% of the ITG group and was not encountered in the ELS group (P = .009). Conclusion ELS provided successful vertigo control at least as well as ITG with a lower incidence of audiovestibular complications. Level of Evidence 4 Laryngoscope, 130:2455–2460, 2020

Outcomes of Endolymphatic Sac Surgery for Meniere’s Disease with and without Comorbid Migraine

“…Moreover, a study by Gibson et al demonstrated similar classes A-B vertigo control between patients receiving ESS and those receiving intratympanic gentamycin injections (73.1% vs. 66.8%, p � 0.76). However, chronic posttreatment unsteadiness was encountered more frequently in the patients receiving intratympanic gentamycin injections compared to patients receiving ESS (25.0% vs. 0%, p � 0.009) [25]. Overall, we had classes A-B vertigo control in 79.17% of patients and decreased FLS from 4.2 to 2.8.…”

“…ESS is an attractive option because it avoids the total hearing loss and permanent vestibular dysfunction seen with labyrinthectomy. On the other hand, intratympanic gentamycin allows the patient to avoid the morbidity of a surgical procedure but has the potential to damage hearing and vestibular function [25]. Previous studies on ESS have demonstrated excellent vertigo control and improvements in FLS scores.…”

Pharmacological, surgical and diagnostic innovations in Meniere’s disease: a review

“…Xu et al 37 suggested that ESS with posterior tympanotomy and local steroid treatment could improve hearing and ensure a satisfactory vertigo control in patients with intractable MD. In Gibson et al opinion 38 , ESS can provide a vertigo control at least as well as IT gentamicin with a lower incidence of audio-vestibular complications 39 . Transmastoid labyrinthectomy alone 40 or in combination with cochlear implantation 41 , grommet insertion 42 , and triple semicircular canal plugging 43 have been proposed as an effective surgical option for the treatment of MD.…”

Recent surgical advances and continued controversies in medically refractory Meniere's disease

“…Mounting evidence supports the use of ELS surgery prior to consideration of intratympanic gentamicin with similar vertigo control. Gentamicin carries a risk of sensorineural hearing loss and a heightened incidence of chronic disequilibrium [45].…”