Does Endolymphatic Sac Decompression Surgery with Local Steroids Prevent Bilateral Development of Ménière's Disease?

Abstract

Objectives: Elucidate whether endolymphatic sac decompression surgery (ESDS) has the potential to prevent unilateral Ménière’s disease (MD) from becoming bilateral. Methods: Prospective case-control study. Between 1996 and 2008, we performed a glycerol test (G-test) and electrocochleography (ECoG) on 237 patients with intractable MD at a tertiary referral center. We performed ESDS on 179 patients (144 without endolymphatic hydrops and 35 with silent endolymphatic hydrops in the contralateral ear). The other 58 patients (40 without endolymphatic hydrops and 18 with silent endolymphatic hydrops in the contralateral ear) were given available medical treatments. All underwent regular follow-up for at least 5 years. Results: Altogether, 22.4% (53/237) of patients with clinically diagnosed unilateral intractable MD had silent endolymphatic hydrops in the contralateral ear using G-test and ECoG. In the nonsurgical group, 6 of 40 patients with unilateral MD without endolymphatic hydops in the contralateral ear developed bilateral disease, whereas in the surgical group, 12 of 144 patients did so ( P > .05). In the nonsurgical group, 9 of 18 patients with unilateral MD and silent endolymphatic hydrops developed the disease in the contralateral ear, whereas in the surgical group, 6 of 35 patients developed bilateral disease ( P < .05). Conclusions: The present findings suggest that ESDS may decrease the incidence of developing MD in silent endolymphatic hydronic contra lateral ears diagnosed with G-test and ECoG within the first 5 postoperative years.