Abstract
Purpose To explore outcomes of endolymphatic sac surgery for patients with Meniere's disease with and without the comorbid condition of migraine. Materials and Methods A retrospective chart review of adult patients undergoing endolymphatic sac surgery at a single tertiary care center from 1987 to 2019 was performed. All adult patients who failed medical therapy and underwent primary endolymphatic sac surgery were included. The main outcome measures were vertigo control and functional level scale (FLS) score. Patient characteristics, comorbidities, and audiometric outcomes were tracked as well. Results Patients with Meniere's disease and migraine had a stronger association with psychiatric comorbidities (64.29% vs. 25.80%, p=0.01), shorter duration of vertigo episodes (143 vs. 393 min, p=0.02), and younger age (36.6 vs. 50.8 yr, p=0.005) at the time of endolymphatic sac surgery. Postoperative pure tone averages and word recognition scores were nearly identical to preoperative baselines. Class A vertigo control (47.92%) was most common, followed by class B vertigo control (31.25%). The FLS score improved from 4.2 to 2.8 (p < 0.001). Both patients with and without migraine had classes A-B vertigo control (66.67% vs. 80.95%) without any statistically significant difference (p=0.59). Of the patients who required secondary treatment (10.42%), none had migraine. Conclusions Endolymphatic sac surgery is an effective surgical intervention for Meniere's disease with and without migraine. Patients with comorbid migraine tend to be younger and present with psychiatric comorbidities.
Highlights
Meniere’s disease is a rare condition with a prevalence of 190 per 100,000 but has detrimental effects on function and quality of life [1]. e condition is defined by (1) two or more spontaneous episodes of vertigo lasting 20 minutes to 12 hours, (2) at least one occasion of audiometrically documented low-to-medium frequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo, (3) fluctuating aural symptoms in the affected ear, and (4) another vestibular diagnosis not better accounted for [2]
These symptoms overlap with other clinical entities making the diagnosis elusive. e American Academy of Otolaryngology (AAO) published several guidelines to assist in the diagnosis, evaluation, and treatment of Meniere’s disease [2, 5]
endolymphatic sac surgery (ESS) decreased the frequency of major vertigo episodes (16.0 vs. 2.4 episodes per month, p < 0.001) and functional level scale (FLS) score (4.2 vs. 2.8, p < 0.001)
Summary
Meniere’s disease is a rare condition with a prevalence of 190 per 100,000 but has detrimental effects on function and quality of life [1]. e condition is defined by (1) two or more spontaneous episodes of vertigo lasting 20 minutes to 12 hours, (2) at least one occasion of audiometrically documented low-to-medium frequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo, (3) fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear, and (4) another vestibular diagnosis not better accounted for [2]. Two studies by Frejo et al have used cluster analysis to identify 5 clinical subgroups of Meniere’s disease, which includes the Type 4 subgroup that is characterized by comorbid migraine [3, 4]. These symptoms overlap with other clinical entities making the diagnosis elusive. Additional treatment consists of intratympanic injection of corticosteroids or gentamicin or surgical options including endolymphatic sac surgery (ESS), vestibular nerve section, and labyrinthectomy. ESS is effective with AAO classes A-B vertigo control of 64.5–77% and minimal risk to hearing [7,8,9]
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