Short-Term Efficacy of Semicircular Canal Occlusion in the Treatment of Intractable Ménière's Disease

Abstract

Objective To investigate the short-term efficacy and safety of triple semicircular canal occlusion （TSCO） in the treatment of intractable Meniere's disease （MD）, so as to provide an alternative surgical procedure for treating MD. Methods Seventeen patients, who had received standardized conservative treatment for at least one year with poor effect, underwent TSCO were retrospectively analyzed. Vertigo control and auditory function were evaluated. Pure tone audiometry, caloric test, and vestibular evoked myogenic potential （VEMP） were performed for evaluation of audiological and vestibular function. Postoperative follow-up period was 6-13 months, with an average of ten months. Results According to the preoperative staging of hearing, among the 17 patients, there were 2 cases in stage Ⅱ （with an average hearing threshold of 25-40 dBHL） and 15 in stage Ⅲ （41-70 dBHL）. No vertigo was found during the follow-up period, with 100% control rate of vertigo. During the same period, we had performed endolymphatic sac decompression operation in 25 MD patients. The control rate of vertigo was 72.0%. The vertigo control rate of TSCO was significantly higher than that of endolymphatic sac decompression operation （X2 = 3.87, P < 0.05）. Three months after surgery, 12 patients showed no significant change in comparison to primary status, 5 patients presented with an mild increase in the average hearing threshold of less than 20 dBHL, with 29.4% of hearing loss rate. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3 days, while, balance disorders were disappeared in 10 patients within 1-2 weeks after surgery, and in another 7 patients within 2 months, with an average recovery time of 12.6 days. Three months after treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in VEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid leakage, and other complications. Conclusions TSCO, which can reduce vertiginous symptoms in patients with intractable MD, represents an effective and safe therapy for this disorder. TSCO is expected to be used as an alternative procedure for the treatment of MD in selected patients suffering from moderate to severe hearing loss. Key words: Meniere's disease; Semicircular canals; Otologic surgical procedures; Treatment outcome