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

Abstract

Purpose Treatment of Menière’s Disease (MD) comprises an array of both non-destructive and destructive treatment options. In patients who are therapy–refractory to non-destructive medical treatment, endolymphatic mastoid shunt surgery (EMSS) is both recommended and debated controversially. The aim of this study was to investigate safety in terms of hearing, vestibular function, complication rate, and efficacy with regards to vertigo control of EMSS in patients with MD according to the current diagnostic criteria of 2015. Methods Retrospective analysis of 47 consecutive patients with definite or probable MD with description of demographic parameters, pre- and postoperative MD treatment, pre- and postoperative audiometric (pure tone audiometry) and vestibular (caloric testing) results. The parameters were compared between patients with and without postoperative vertigo control. Results 31/47 patients (66.0%) had improved vertigo control postoperatively. Postoperative hearing and vestibular preservation were predominantly stable. No significant differences between patients with improved vertigo control and patients with no change or worse vertigo episodes were found. In the treatment refractory group, 4 patients required a revision EMSS and 6 a destructive MD treatment (5 gentamicin intratympanically, 1 labyrinthectomy). No peri- or postsurgical complications were reported. Conclusions EMSS was found to be beneficial in two thirds of the patients with definite or probable Morbus Menière and a safe procedure regarding hearing and vestibular preservation with no postoperative complications. Therefore, EMSS should be considered before inducing destructive treatment options, such as intratympanic gentamicin application or labyrinthectomy.

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

“…ELS surgery is a well tolerated and effective first-line surgical option in Meniere's disease -vestibular function is not decreased when evaluating caloric responses, vestibular-evoked myogenic potential (VEMP) responses, or video head impulse testing (VHIT), despite a decrease in vertigo episodes, and quality-of-life scores are positively associated with surgery [46]. 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].…”