ABSTRACT
OBJECTIVES/HYPOTHESIS: Comparison of audiometric outcomes between patients with definite Meniere's disease who underwent endolymphatic mastoid sac surgery (EMSS) following failed medical therapy and patients who underwent medical therapy only. STUDY DESIGN: Retrospective chart review of 456 consecutive patients between 1997 and 2006. METHODS: Outcome measures were changes in pure-tone average (PTA), word recognition score (WRS), and speech reception threshold (SRT). RESULTS: Of 58 qualified patients, 29 who underwent EMSS after failing medical therapy showed a 4 dB decrease in PTA, a 2% increase in WRS, and a 2 dB decrease in SRT. Twenty-nine patients treated with medical therapy only demonstrated a 1 dB PTA increase, 2% WRS improvement, and 2 dB SRT improvement. No significant difference was noted between the medically and surgically managed patients in terms of changes in PTA (P = .34) or WRS (P = .95) after treatment. Of all patients in the study, 60% had no clinically significant change in hearing, whereas 24% improved and 16% worsened. The distribution of post-treatment hearing changes between the medical and surgical groups was statistically insignificant (P = .17). CONCLUSIONS: The changes in PTA and WRS among patients with Meniere's disease managed with medical therapy or EMSS were not statistically significant. Although performing EMSS to treat the vertigo of Meniere's disease does not appear to be associated with an increased risk of deteriorating auditory function after treatment, surgery also does not confer an increased likelihood of stabilizing or improving hearing.
Subject(s)
Endolymphatic Sac/surgery , Hearing Loss , Mastoid/surgery , Meniere Disease/surgery , Adult , Aged , Audiometry, Pure-Tone , Endolymphatic Sac/physiopathology , Female , Hearing Loss/etiology , Hearing Loss/physiopathology , Hearing Loss/prevention & control , Humans , Male , Mastoid/physiopathology , Meniere Disease/physiopathology , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE OF REVIEW: To determine the current options available for the treatment of snoring in the symptomatic patient, as this can be troublesome not only for the patient, but also the patient's bed partner. These include both surgical and non-surgical measures. RECENT FINDINGS: The main themes that will be addressed include over-the-counter snoring aids, oral appliances, and surgical options. Surgical options include uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, radiofrequency thermal ablation therapy, injection snoreplasty, and palatal implants. SUMMARY: There are many alternatives available to treat snoring. None of these methods are without their negative aspects, therefore there is still a great need for further research and long-term follow-up studies to determine the best method. The final consensus of this review is that surgical options yield the best results, but these are often surgeon dependent, and none are free of relapses in snoring. Some options are also thought to offer several advantages, including less peri-operative pain and recovery time, less expense, and the ability to be performed in the office. The palatal implant system and radiofrequency thermal ablation appear to have relatively good outcomes, with little postoperative pain and relatively self-limited complications. They also have the convenience of an in-office procedure and less expense.