Endolymphatic duct and sac decompression: A new technique for Ménière’s disease treatment

Abstract

Background: The present article aims to introduce the endolymphatic duct and sac decompression technique (DASD) and to give a spotlight on its benefits in Ménière’s disease (MD) treatment. Methods: Eighty-two patients with intractable MD which met the inclusion criteria were recruited and underwent DASD. This technique allows a meningeal decompression of the duct and the sac from the posterior cranial fossa to the labyrinthine block. The authors considered as main outcomes, the change of the dizziness handicap inventory (DHI) results, with the evaluations of the three sub-scales (Functional scale, Physical scale, and Emotional scale); ear fullness and tinnitus change on the perceptions of the patient; and hearing stage with four-Pure Tone Average (500 hz-1000 hz-2000 hz-4000 hz). The differences between the preoperative and the postoperative score were evaluated. A comparison with the literature was conducted. Results: After a 14-month follow-up, patients that underwent DASD reported a remarkable improvement of the symptoms in all three functional scales, confirmed by the total DHI. The difference between preoperative and postoperative scores is statistically significant. The data describe an ear fullness and tinnitus improvement. The multi-frequency tonal average before and after the surgery does not suggest a worsening of the value for any of 82 patients. Conclusion: The modification of sac surgery includes the endolymphatic duct in the decompression area allowing inner ear functional improvement, vertigo control, ear fullness improvement with minimal risk of facial nerve paralysis, and hearing loss. DASD is an improved old surgical technique.

Endolymphatic Duct and Sac Decompression: A New Life for an Old Technique

“…The authors have already described how to decompress both the duct and the endolymphatic sac using bone pâté and named DASD, meaning duct and sac decompression. 7 …”

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

“…Audiometric measures also appear to be stable following surgery [47]. Additional decompression of the endolymphatic duct may be beneficial in the treatment of Meniere's disease, as described by Salvinelli et al (2022) [48]. When Zheng et al [49] in 2022 compared local decompression, sac-mastoid shunting, and wide decompression (including the duct) within a series of 83 patients, a clear advantage in vertigo control was shown in the wide decompression group.…”