Abstract
BackgroundTo explore the long-term efficacy and safety of resection of the lateral wall of the endolymphatic sac for the treatment of intractable Meniere's disease (MD) as an alternative surgical procedure for treating this disorder.MethodsData from 73 patients who were referred to our hospital and diagnosed with unilateral MD between January 2015 and June 2019 were retrospectively analyzed in this study. Seventy-three patients who had frequent vertigo even after receiving standardized conservative treatment for at least half a year underwent resection of the lateral wall of the endolymphatic sac. Vertigo control and auditory function were assessed. Pure tone audiometry, caloric test, and vestibular evoked myogenic potential were performed to evaluate audiological and vestibular functions. The post-operative follow-up duration was more than 2 years.ResultsAmong the 73 patients (male 34 cases, female 39 cases; age 20–69 years, average 51.4), vertigo was controlled effectively for 66 cases (90.4%) after 2 years of follow-up; 45 cases (61.6%) were completely controlled, and 21 cases (28.8%) were substantially controlled in this study. The patients of 16.4% had hearing loss with more than 10 dB change based on the four-tone average (0.5, 1, 2 and 3 kHz). No patient had a facial nerve weakness, cerebrospinal fluid leakage, or other complications.ConclusionResection of the lateral wall of the endolymphatic sac, which can effectively control vertiginous symptoms in intractable MD patients, represents an effective and safe therapy for this disease. Resection of the lateral wall of the endolymphatic sac is expected to be used as an alternative treatment for MD.
Highlights
Meniere’s disease (MD) is a common inner ear disorder characterized with intermittent episodes of vertigo, fluctuating sensorineural deafness, tinnitus, and/or aural pressure
We found that vertigo was controlled effectively in 90.4% of the 73 patients with MD who were treated with lateral wall resection of the endolymphatic sac at the 2-year follow-up
Immunohistochemical and ultrastructural studies showed that the endolymphatic sac of MD patients had excessive secretion of glycoprotein [13, 14], and the overexpression of aquaporin2 in the endolymphatic sac epithelium was involved in the formation of endolymphatic hydrops [15], suggesting that the endolymphatic sac secretion exceeded absorption, increasing the inner ear pressure
Summary
Meniere’s disease (MD) is a common inner ear disorder characterized with intermittent episodes of vertigo, fluctuating sensorineural deafness, tinnitus, and/or aural pressure. Its prevalence ranges from 3.5% to 513 per 1,00,000 [1].There is currently no cure for this disease because its pathogenesis has not been established; ∼80% patients can be free from vertigo after changes in lifestyle and medical treatment [1]. Treatment of Meniere’s Disease treatment fails to control vertigo. Endolymphatic sac surgery is widely used in patients with intractable MD; the rate of vertigo control is only 60–80%, and the benefit of this surgery is still debated [2–4]. To explore the long-term efficacy and safety of resection of the lateral wall of the endolymphatic sac for the treatment of intractable Meniere’s disease (MD) as an alternative surgical procedure for treating this disorder
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