Endolymphatic Duct Blockage for Refractory Ménière's Disease: Assessment of Endolymphatic Sac Biopsy on Short-Term Surgical Outcomes.

Abstract

Endolymphatic sac decompression (ESD) for the treatment of Ménière's disease (MD) has had limited success and variable results in the literature. We have devised a novel technique that involves blocking the endolymphatic duct with surgical clips. In a separate effort to study the endolymphatic sac (ELS), we have sectioned the lateral part of the main body of the ELS as biopsies from a subset of patients. We aimed to evaluate the effect of the lateral part sectioning of the ELS on short-term surgical outcomes. This was a single-physician, retrospective study in a tertiary medical center. MD patients underwent endolymphatic duct blockage (EDB) surgery with or without ELS biopsy. The assessed surgical outcomes were the occurrence of benign paroxysmal positional vertigo (BPPV), intraoperative CSF leaks, aural fullness, tinnitus, vertigo spells, and pure tone audiometry. Data were collected at the following visits: preoperatively 1st week, 1st month, and 6th months. A total of 63 patients were included. The outcomes of the biopsy group (EDB+B) (n=27) were compared to those of the EDB group (n=36) at each visit. There was no significant difference in the occurrence of postoperative BPPV, CSF leaks, aural fullness, tinnitus, or vertigo spells. The SDS, the PTA, and bone conduction were not significantly different at any visit, and PTA variations were similar in both groups. Our results suggest that aggressive decompression of the ELS by sectioning the sac does not benefit patients in the early postoperative period. The short-term success of EDB surgery is attributable to the effective obstruction of the endolymphatic duct regardless of pressure in the ELS.