Endolymphatic Sac Surgery for Ménière's Disease

Abstract

Objective: To analyze the results of primary and revision endolymphatic sac surgery for the treatment of Ménière's disease in patients who failed medical therapy.Design: Retrospective medical chart review.Setting: Tertiary referral center.Patients: Fifty-one adult patients with Ménière's disease who failed medical therapy.Interventions: Endolymphatic sac to mastoid shunts were performed. Revision sac procedures were performed in patients who developed clinically significant recurrent vertiginous spells 5 months or longer after their original procedure.Main Outcome Measures: Frequency of major vertiginous episodes measured by the standards listed in the 1995 American Academy of Otolaryngology guidelines for evaluation of therapy in Ménière's disease.Results: Twenty-four months after primary sac surgery, 27 patients (53%) exhibited class A results (no vertigo), and 12 (24%) exhibited class B results (1%-40% of baseline). In 14 patients undergoing revision sac surgery, 5 (36%) showed class A results and 4 (29%) showed class B results. Patients who failed treatment with sac surgery more than 24 months after their primary procedure obtained better results than those who failed treatment less than 24 months after their initial sac procedure. In the 37 patients who had long-term follow-up (mean duration of follow-up, 88 months) after their last sac procedure, 57% exhibited class A results (21 cases) and 35% exhibited class B results (13 cases).Conclusions: Endolymphaticsacsurgeryprovidedimprove-mentinmajorspellsofvertigoin77%ofpatientsat24months aftersurgery.Revisionsurgeryprovidedimprovementin65% of cases. Results of revision surgery were better in those patients who developed recurrent symptoms more than 24 months after their original procedure compared with those of patients who failed treatment earlier.

Meniere’s Disease: Nonsurgical Treatment

“…Kitahara et al's study reported the results of patients who had endolymphatic sac drainage with and without insertion of steroid induced silastic and nonsurgical group. The vertigo control rates were similar in surgery groups with or without steroid, but hearing levels of steroid group had better long-term results than nonsteroid surgery group and nonsurgical group [172]. Their findings were also supported with review of Wetmore.…”

Successful treatment of relapsed Ménière’s disease using selective serotonin reuptake inhibitors: A report of three cases

“…The gentamicin injection may be performed without hospital admission, but the surgery requires hospitalization. There is a risk of hearing impairment following gentamicin injection and success of either treatment have been previously reported (2,3). Thus far there has only been one study concerning the treatment of Ménière’s disease by SSRIs (3).…”

“…Intratympanic gentamicin injections (1) or revision surgery (2) have been used for the treatment of patients with Ménière’s disease who have relapsed following endolymphatic sac surgery (EDS) or intratympanic gentamicin injection. Ménière’s disease is a condition with vertigo, tinnitus (ringing or buzzing noises in the ears) and progressive deafness.…”

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

“…For example, labyrinthectomy is the gold standard for vertigo control but is a destructive procedure resulting in a total loss of hearing [6]. ESS is effective with AAO classes A-B vertigo control of 64.5-77% and minimal risk to hearing [7][8][9].…”