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Objective To investigate the clinical effect and hearing loss of endolymphatic sac decompression(ESD)combined with one or two semicircular canal obstruction(SCO)in treating the patient with stage Ⅲ or stageⅣ Meniere disease.Methods Forty-three patients with stage Ⅲ or stage Ⅳ Meniere disease,who failed to respond to conventional conservative treatment and had the expectation of preserving residual hearing function,were enrolled in the study.They were divided into three groups according to the operation they underwent:ESD combined with lateral and posterior semicircular canal obstruction(ESD+LPSCO)13 cases,ESD combined with lateral semicircu-lar canal obstruction(ESD+LPSCO)14 cases,and ESD only 16 cases.Data of vertigo,ear fullness and tinnitus be-fore and after operation was collected,analyzed and compared.Hearing function before and after the operation was also evaluated.Results The number of vertigo attacks in the three groups(ESD+LPSCO,ESD+LSCO,and ESD)were all significantly reduced after operation.The vertigo control rate were 92.3％,78.6％and 62.5％re-spectively.Compared with pre-operation,the vertigo severity post-operation in the three groups were also signifi-cantly reduced.And the improvement rate of vertigo severity after ESD+LPSCO and ESD+LSCO were both 100％,which were significantly higher than that of ESD(68.8％).The discomfort of tinnitus and ear fullness in the three groups were significantly improved compared with that of pre-operation.The improvement rates of tinnitus in the three groups were 46.2％,50.0％and 43.8％respectively,with no significant difference.The improvement rate of ear fullness in the three groups were 61.5％,57.1％and 50.0％respectively,with no significant difference either.The proportion of patients with decreased hearing after operation in the three groups was 15.4％,7.1％and 18.8％,respectively,and the differences were insignificant.Conclusion ESD combined with one or two SCO can effectively control vertigo and other symptoms of patients with stage Ⅲ or Ⅳ Meniere's disease who had failure to conventional conservative treatment,and can preserve the residual hearing function in considerable extent.
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Abstract Introduction The endolymphatic sac is thought to maintain the hydrostatic pressure and endolymph homeostasis for the inner ear, and its dysfunction may contribute to the pathophysiology of Ménière's disease. Throughout the years, different surgical procedures for intractable vertigo secondary to Ménière's disease have been described, and though many authors consider these procedures as effective, there are some who question its long-term efficacy and even those who think that vertigo control is achieved more due to a placebo effect than because of the procedure itself. Objective To review the different surgical procedures performed in the endolymphatic sac for the treatment of Ménière's disease. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis We focus on describing the different surgical procedures performed in the endolymphatic sac, such as endolymphatic sac decompression, endolymphatic sac enhancement, endolymphatic sac shunting and endolymphatic duct blockage, their pitfalls and advantages, their results in vertigo control and the complication rates. The senior author also describes his experience after 30 years of performing endolymphatic sac surgery. Conclusions The endolymphatic sac surgery, with all its variants, is a good option for patients with incapacitating endolymphatic hydrops, providing a high percentage of vertigo control and hearing preservation.
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Objective To study the effects of endolymphatic sac decompression and on semicircular canal plugging in treating intractable Meniere's disease.Methods A total of 14 cases of intractable Meniere's disease were included in this study.The age was from 33~67 years old and the history was from 1 to 40 years.The hearing level of bone was from 35 to 65 dB for the speech frequencies.All cases received the treatments according to the pre-op-erative design.The endolymphatic sac was decompressed and the three semicircular canal bones were drilled to cre-ate a fenestra followed by soft tissue plugging into the canal.The vertigo,hearing level and tinnitus were included in the following up.Results All cases had no facial palsy,no cerebrospinal leak,and no vertical after surgery.In the period of 3 to 18 months following up,the attack of Meniere's disease was completely controlled for 13 cases excep-tion of one lost case.For five cases,the hearing level descended 10 to 15 dB compared to pre-operation.Conclusion Although the endolymphatic sac decompression can relieve endolymphatic pressure,this may not adequately pro-tect the hearing caused by the semicircular canal plugging.The surgical technique is reliable and safe;however fur-ther clinical data should be gathered.
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There are only a few reports of post-traumatic Meniere's disease and there is few literature that contains detailed data associated with the disease. We report a case of post-traumatic Meniere's disease. He suffered from tinnitus, fluctuating sensorineural hearing loss, and recurrent vertigo. Symptomatic medical treatment was not helpful and neither was soft tissue plugging around the oval and round windows during exploratory tympanotomy. Three months after soft tissue plugging, endolymphatic sac decompression surgery was performed. The patient's symptoms improved markedly thereafter. The clinical significance of post-traumatic Meniere's disease is described and we present a brief review of the literature.
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Descompresión , Hidropesía Endolinfática , Saco Endolinfático , Pérdida Auditiva Sensorineural , Enfermedad de Meniere , Acúfeno , VértigoRESUMEN
Evaluar eficacia del procedimiento quirúrgico de descompresión del saco endolinfático (DSE) en mejoramiento de calidad de vida de los pacientes con enfermedad de Meniere intervenidos con DSE utilizando como criterios principales la evaluación de la audición y del vértigo en pacientesatendidos en el Centro Médico Imbanaco entre 2003 y 2007. Materiales y métodos: Estudio de intervención retrospectivo, comparativa (antes-después) en 30 pacientes operados de DSE, se evaluó audición y calidad de vida desde el aspecto de la funcionalidad. Resultados: Mejoría en la calidad de vida de los pacientes operados en los cuales la media de la encuesta del nivel funcional fue de 1.63 mientras que la prequirúrgica fue de 4.06 (p=0.00). No se presentaron cambios significativos en la audición siendo la media de la prequirúrgica de 40.6 y la post de 42.1.
Objective: To evaluate the efficacy of the surgical decompression of the endolymphatic sac (ESD) for the improvement of the quality of life of patients with Menieres disease using the patients vertigo control and hearing assessment as the main criteria in patients that have been operated on. Materials and methods: We performed a retrospective interventional study, comparative (beforeafter) in 30 patients with ESD at the Imbanaco Medical Center between 2003 and 2007. The quality of life and hearing preservation was assessed from the aspect of functionality. Results: Improvement in the quality of life was evident in patients who were operated on. The average functional level at the survey was 1.63 after the surgical intervention while the preoperative average was 4.06 (p=0.00). There were no significant changes in the hearing level being the preoperative mean of 40.6 and thepostoperative 42.1.
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Enfermedad de Meniere/diagnóstico , Enfermedad de Meniere/rehabilitación , Enfermedad de Meniere/terapiaRESUMEN
Objective:To investigate the efficacy of endolymphatic sac surgery for Meniere's disease,and compare the effects of endolymphatic sac decompression with endolymphatic-mastoid shunting.Method:Twelve patients(13 ears)undergoing endolymphatic-mastoid shunting and eleven patients (11 ears) undergoing endolymphatic sac decompression were retrospectively compared for hearing results and vertigo controlled rates.All of them have been followed up for more than two years after surgery.Result:According to Chinese Meniere's disease diagnosis and curative effect standard evaluation criteria pubilished in 2006,for vertigo symptom of endolymphaticmastoid shunting group,9 cases(69.2%) achieved grade A(eompletely controlled),4 cases (30. 8%) achieved grade B(fundamentally controlled).There were 8 cases(72.7%)with grade A, 2 cases (18.2%)with grade B and one case(90% ) with grade C among 11 patients who received endolymphatic sac decompression.There was not statistically significant differences in postoperative speech pure tone average and vertigo controlled rate between the two groups.Conslnsion:Endolymphatic sac decompression and endolymphatic-mastoid shunting are effective management with less complication for intractable Meniere's disease. Particularly,the vertigo symptoms were controlled signifisantly. Patients with Meniere's disease in advanced clinical stages may also be relieved.
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BACKGROUND AND OBJECTIVES: The treatment result of endolymphatic sac decompression (ELSD) is controversial especially after a long term follow-up period. The aims of this study are to review the long term treatment outcome of ELSD and to analyzethe factors associated with the long term prognosis. SUBJECTS AND METHOD: A retrospective review of medical records was performed. Sixteen patients (18 ears) who had been diagnosed with definite Meniere's disease, had undergone ELSD and been followed up for more than 2 years were included in this study. The average follow up period was 88.6 months, with the range spanning from 25.7 to 243.4 months. All results were described according to the 1995 AAO-HNS criteria. RESULTS: After a long term follow-up, vertigo was successfully controlled in 66.6% and hearing was preserved or improved in 58.8%. Tinnitus and aural fullness were relieved in 27.3% and 60.0% respectively. The preoperative hearing threshold (p=0.03) and caloric test (p=0.05) showed a close relationship with the long term vertigo control after ELSD. CONCLUSION: Although vertigo and hearing may deteriorate again after 2 years, ELSD generally seems to be able to control vertigo even after a long term follow up. Preoperative hearing threshold and caloric test may be able to serve as prognostic factors.