A comparison of endolymphatic duct blockage, endolymphatic sac drainage and endolymphatic sac decompression surgery in reversing endolymphatic hydrops in Meniere\u2019s disease

Anquan Peng,Chao Huang,Wenqi Jiang,Junjiao Hu,Qin Wang,Yichao Chen,Zhiwen Zhang,Xueying Pan

doi:10.1186/s40463-021-00545-7

Abstract

BackgroundTo explore the differences between endolymphatic duct blockage, endolymphatic sac drainage and endolymphatic sac decompression surgery in the reversal of endolymphatic hydrops (EH) in patients with intractable Meniere’s disease (MD).MethodsA total of 27 MD patients receiving endolymphatic duct blockage surgery (n = 10), endolymphatic sac drainage surgery (n = 9) and endolymphatic sac decompression surgery (n = 8) underwent gadolinium-enhanced inner ear magnetic resonance imaging (MRI) scans prior to, 2 weeks after and at > 12 months following surgery.ResultsIn the group with endolymphatic duct blockage, the second MRI revealed no changes in EH, whereas the third MRI revealed a reversal of vestibular EH in 3 patients and a downgrading of cochlear hydrops in 2 of these 3 patients, who presented with an improvement in their hearing and complete control of vertigo. In the group with endolymphatic sac drainage, the second MRI showed a reversal of EH in 4 patients, and no changes in EH in the remaining 5 patients, whereas the third MRI showed that those 4 patients who presented with a reversal of EH at the second MRI stage remained unchanged except a recurrence of vestibular hydrops in 1 patient. All 4 patients exhibited a complete control of vertigo, but hearing improved in 1, worsened in 1 and remained unchanged in 2. In the group with endolymphatic sac decompression, both the second and third MRI examination revealed no reversal of EH.ConclusionsThe present study has shown that both endolymphatic duct blockage surgery and endolymphatic sac drainage surgery have the potential to reduce EH in certain MD patients, but none of the patients receiving endolymphatic sac decompression surgery showed reversal of their EH.Graphical

Highlights

Meniere’s disease (MD) is characterized by episodic vertigo, fluctuating sensorineural hearing loss and aural symptoms [1]
In order to compare the dynamic changes of endolymphatic hydrops (EH) between the patients enrolled in the present study in three groups, a second magnetic resonance imaging (MRI) examination was performed 2 weeks after surgery, and a subsequent third MRI examination was performed at a > 12-month interval following surgery
The results of the third MRI scans showed a reversal of vestibular EH in 3 patients, accompanied by a downgrading of cochlear hydrops in 2 patients, who showed an improvement in their hearing and complete control of vertigo attacks

Summary

Introduction

Meniere’s disease (MD) is characterized by episodic vertigo, fluctuating sensorineural hearing loss and aural symptoms [1]. The specific underlying pathophysiological mechanisms of MD remain unknown, the presumed cause of the symptoms experienced in MD is considered to be due to endolymphatic hydrops (EH), which is characterized by an enlargement of the cochlear and vestibular endolymphatic space [1]. The efficacy of these treatments has not been proved, and the mechanisms underlying their effects remain speculative With such sac surgery, it is unclear whether the EH in patients with MD can be reduced, and if it should happen, it is not clear when the reduction in EH occurs or how the reduction of EH is associated with the dynamics of hearing threshold and vertigo attacks. To explore the differences between endolymphatic duct blockage, endolymphatic sac drainage and endolymphatic sac decompression surgery in the reversal of endolymphatic hydrops (EH) in patients with intractable Meniere’s disease (MD)

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