Endolymphatic Sac Decompression Surgery Research Articles

Clinical Outcomes of Endolymphatic Sac Decompression Surgery in Menière’s Disease

Objectives: Endolymphatic sac decompression surgery (ESDS) is one of the surgical methods for intractable Menière’s disease (MD), and it is known as a relatively safe treatment that does not cause hearing loss. However, the effectiveness and the degree of vertigo control rate of ESDS are still controversial. In this study, we aimed to evaluate the clinical outcomes of ESDS in intractable MD.Methods: We retrospectively reviewed 33 patients who underwent ESDS for intractable MD from January 2002 to March 2022. Clinical characteristics of patients, pure tone threshold, medical treatment method, and number of vertigo attacks before and after surgery were assessed. The improvement of hearing and vertigo was evaluated according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery criteria.Results: Of the 33 patients, the average follow-up period was 21.2 months, with immediate follow-up within 2 months (28 patients), short term between 2 and 6 months (27 patients), and long term at 12 months or later (29 patients). In the immediate hearing threshold, both air conduction and bone conduction showed slight deterioration, but there was no significant change in the long-term hearing threshold. At long-term follow-up, 12 patients (41.4%) were able to live without medication, and 18 patients (62.1%) showed improvement in their vertigo symptoms. In addition, patients who showed improvement in hearing also showed improvement in vertigo at the same time.Conclusions: ESDS in intractable MD is a relatively safe and effective treatment method for reducing vertigo attack without worsening hearing threshold.

Development and validation of prediction model to estimate vertigo risk after endolymphatic sac decompression in Meniere's disease: a retrospective cohort study.

To study the efficacy predictors of endolymphatic sac decompression (ESD) in Meniere's disease (MD), and to establish and verify the prediction model of vertigo after ESD in patients with MD. The retrospective cohort data of 56 patients with unilateral MD who underwent ESD surgery were recorded. A stepwise regression method was used to select optimal modeling variables, and we established a logistic regression model with the outcome of vertigo after ESD. The bootstrap method was used for internal validation. Potential predictors included sex, age, follow-up duration, disease course, attack duration, frequency of attack, pure-tone threshold average (PTA) of the patient's speech frequency, audiogram type, glycerin test results, MD subtype, and 10-year atherosclerotic cardiovascular disease risk classification. Using the stepwise regression method, we found that the optimal modeling variables were the audiogram type and PTA of the patient's speech frequency. The prediction model based on these two variables exhibited good discrimination [area under the receiver operating characteristic curve: 0.72 (95% confidence interval: 0.57-0.86)] and acceptable calibration (Brier score 0.21). The present model based on the audiogram type and PTA of the patient's speech frequency was found to be useful in guidance of ESD efficacy prediction and surgery selection.

The effect of vascular risk factors on the efficacy of endolymphatic sac decompression surgery for Meniere's disease: a retrospective cohort study.

This study aimed to investigate the effect of vascular risk factors on the outcomes of endolymphatic sac decompression (ESD) surgery in patients with Meniere's disease. The study included 56 patients with Meniere's disease, who had undergone unilateral ESD surgery. The patients' vascular risk factors were assessed based on the preoperative 10-year atherosclerotic cardiovascular diseases risk classification. Those with no or low risk were defined as the low-risk group, while those with medium, high, or very high risk were defined as the high-risk group. The correlation between the vascular risk factors and ESD efficacy was evaluated by the comparison of vertigo control grade between the two groups. The functional disability score was also assessed to investigate whether ESD improved the quality of life in Meniere's disease patients with vascular risk factors. After ESD, 78.95 and 81.08% of patients from the low-risk and high-risk groups, respectively, demonstrated at least grade B vertigo control; no statistically significant difference was observed (p = 0.96). The postoperative functional disability scores in both groups were significantly lower compared with those before surgery (p < 0.01), with a median decrease of two (1, 2) points in both groups. No statistically significant difference between the two groups was observed (p = 0.65). Vascular risk factors have little effect on the efficacy of ESD in patients with Meniere's disease. Patients with one or more vascular risk factors can still experience a not poor vertigo control and improved quality of life after ESD.

Menière's Syndrome Associated With Fibrous Dysplasia of the Temporal Bone.

Menière's Syndrome Associated With Fibrous Dysplasia of the Temporal Bone.

Endolymphatic sac decompression effect on secondary symptoms of Meniere's disease

ObjectiveTo evaluate if endolymphatic sac decompression (ESD) significantly improves secondary symptoms of Meniere's disease including tinnitus and aural fullness. Study designSurvey study with retrospective chart review. SettingTertiary care center. MethodsSurvey of adult patients with Meniere's disease that underwent primary ESD surgery from 2015 to 2020. Subjective reporting of pre- and postoperative aural fullness and tinnitus based on postoperative survey. Survey results and audiologic data of the patients that reported were compared pre- and postoperatively. ResultsStatistical analysis was performed using weighted kappa statistics to examine the level of agreement. There was a value of 0.12 for pre- and postoperative aural fullness, indicating a difference in the two groups with 77 % having improvement and only 4 % having worsening. There was a value of 0.21 for pre- and postoperative tinnitus, demonstrating a lack of agreement with 58 % having improvement and 4 % having worsening. Overall, there was significant improvement in both tinnitus and aural fullness postoperatively. There was no significant difference in word recognition score, speech reception threshold, or pure tone average between the pre- and postoperative group based on paired t-test. ConclusionsThere is a significant improvement in both aural fullness and tinnitus for patients undergoing ESD with no negative effect on audiologic status. ESD is a viable option for treatment of Meniere's disease with vertigo, aural fullness, and tinnitus relief. Future prospective studies are needed to further improve the evidence of ESD's effect on secondary symptoms of Meniere's disease.

A comparison of endolymphatic duct blockage, endolymphatic sac drainage and endolymphatic sac decompression surgery in reversing endolymphatic hydrops in Meniere\u2019s disease

BackgroundTo explore the differences between endolymphatic duct blockage, endolymphatic sac drainage and endolymphatic sac decompression surgery in the reversal of endolymphatic hydrops (EH) in patients with intractable Meniere’s disease (MD).MethodsA total of 27 MD patients receiving endolymphatic duct blockage surgery (n = 10), endolymphatic sac drainage surgery (n = 9) and endolymphatic sac decompression surgery (n = 8) underwent gadolinium-enhanced inner ear magnetic resonance imaging (MRI) scans prior to, 2 weeks after and at > 12 months following surgery.ResultsIn the group with endolymphatic duct blockage, the second MRI revealed no changes in EH, whereas the third MRI revealed a reversal of vestibular EH in 3 patients and a downgrading of cochlear hydrops in 2 of these 3 patients, who presented with an improvement in their hearing and complete control of vertigo. In the group with endolymphatic sac drainage, the second MRI showed a reversal of EH in 4 patients, and no changes in EH in the remaining 5 patients, whereas the third MRI showed that those 4 patients who presented with a reversal of EH at the second MRI stage remained unchanged except a recurrence of vestibular hydrops in 1 patient. All 4 patients exhibited a complete control of vertigo, but hearing improved in 1, worsened in 1 and remained unchanged in 2. In the group with endolymphatic sac decompression, both the second and third MRI examination revealed no reversal of EH.ConclusionsThe present study has shown that both endolymphatic duct blockage surgery and endolymphatic sac drainage surgery have the potential to reduce EH in certain MD patients, but none of the patients receiving endolymphatic sac decompression surgery showed reversal of their EH.Graphical

Effects of endolymphatic sac decompression combined with posterior tympanotomy with local steroids for intractable Meniere’s disease

Background: Endolymphatic sac decompression surgery (ESDS) is commonly used for intractable Meniere’s disease, but its effect remains controversial because of the low rate of vertigo control.Objectives: In the present study, we examined ESDS combined with posterior tympanotomy with local steroids as a new therapeutic strategy for intractable Meniere’s disease.Materials and methods: This retrospective study enrolled 19 patients with Meniere’s disease using ESDS combined with posterior tympanotomy with local steroids between 2015 and 2018. Postoperatively we recorded and evaluated changes in vertigo attack frequency and hearing level.Results: Vertigo episodes decreased from 3.6 ± 3.2 times preoperatively to 0.2 ± 0.5 times postoperatively, with 89.5% complete vertigo control rate. Mean PTA decreased from 40.5 ± 21.3 dB to 39.5 ± 17.5 dB postoperatively, with 21.1% improvement rate.Conclusions and significance: The present findings suggest that ESDS combined with posterior tympanotomy with local steroids could improve clinical results of hearing as well as vertigo control for intractable Meniere’s disease.

Intraoperative Electrocochleography in Patients With Menière's Disease Undergoing Endolymphatic Sac Decompression and Shunt Surgery.

Objective physiologic changes measured using electrocochleography at the round window (ECOG) are observable during endolymphatic sac decompression and shunt surgery (ELS). Limited effective treatment options are available to patients with Menière's disease (MD) who have failed conservative management, experience persistent vertigo symptoms, and have substantial residual hearing. ELS is a feasible therapeutic option for these patients. However, the efficacy of this procedure has been questioned, and objective measures assessing inner ear physiologic alterations are lacking. ECOG was measured in patients with MD undergoing ELS. Stimuli consisted of tone bursts (250, 500, 1000, 2000, 4000 Hz) and 100 μs broadband clicks at various intensities (60-90 dB nHL). Cochlear microphonic (CM), summation potential (SP), compound action potential (AP), SP:AP ratio, and CM harmonic distortions were measured. ECOG was completed in 18 patients. The mean SP magnitude at 500 Hz changed significantly from -7.1 μV before to -5.1 μV after ELS (p < 0.05). However, the mean SP:AP ratio in those tested (n = 13) did not significantly change after ELS. CM harmonic magnitudes remained unchanged from pre- to post-ELS (n = 12) across all frequencies. ECOG allows detection of acute electrophysiological changes in the cochlea. However, our results indicate only small objective changes in the low-frequency SP magnitude (500 Hz) immediately after ELS, but not in other frequencies or measures tested (CM, SP:AP, CM harmonic distortions). These results suggest minimal electrophysiological changes occur in the cochlea as a result of ELS.

The prognostic value of glycerol test of electrocochleography on the effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease

Objective:To determine whether the preoperative results of glycerol test of electrocochleography and hearing stage have a prognostic value on the effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease. Method:A retrospective study was conducted of 58 unilateral Meniere's disease patients who underwent endolymphatic sac decompression surgery. The correlation between the preoperative results of glycerol test of electrocochleography， hearing stage and vertigo control was analyzed by Kendall test. Result:Patients in the positive glycerol test of electrocochleography group had better vertigo control after the decompression of the lymphatic sac than the negative group(P=0.029). Preoperative hearing staging was significantly associated with vertigo control after endolymphatic sac decompression(P=0.028). The better the preoperative hearing, the higher the control rate of vertigo after endolymphatic sac decompression. The stage Ⅰ patients were 91.7%, the stage Ⅱ patients were 78.1%, and the third stage Ⅲ patients were 57.1%, respectively. Conclusion:Our findings suggested that the positive preoperative results of glycerol test of electrocochleography and better hearing stage may indicate a better effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease.

Postoperative anxiety and its relationship with life quality in patients with Ménière's diseases

To investigate the postoperative anxiety and its relationship with life quality in patients with Ménière's diseases. Methods: A total of 68 patients with Ménière's disease, who received the treatment of endolymphatic sac decompression from 2010 to 2016, were enrolled. They finished two scales (the self-rating anxiety scale and the quality of life questionnaire for endolymphatic sac decompression of Ménière's disease) by snail mail. The patients were divided into different groups based on their preoperative course, postoperative follow-up time, clinic stage and quality of life after endolymphatic sac decompression surgery, and their anxiety was analyzed. In addition, 109 gender and age-matched patients with other diseases of otorhinolaryngology served as the control group, and their anxiety was also analyzed. Results: There was no statistical difference in the postoperative anxiety among the patients with preoperative course for less than 1 year, 1 to 5 years or more than 5 years (all P>0.05). There was no statistical difference in the patients with different duration of follow-up (P>0.05). There was no statistical difference in the patients with the different clinic stages (all P>0.05). There was no statistical difference in the patients with the improved life or non-improved life after surgery (P>0.05). The degree of the anxiety in the Ménière's group was more severe than that in the control group (P<0.01). Conclusion: It needs to keep in mind that a certain degree of postoperative anxiety still keeps in patients with Ménière's disease.

Endolymphatic Sac Decompression With Intra-Sac Dexamethasone Injection in Menière's Disease.

Endolymphatic sac decompression surgery (ELSD) may be used to treat patients who have Menière's 's disease refractory to medical therapy. In this study, we investigated whether or not the injection of steroid into the endolymphatic sac at the time of ELSD provides additional benefit to patient outcomes. Randomized prospective single-blinded placebo-controlled study. Tertiary center. Patients with Menière's disease with poorly controlled vertigo despite medical therapy and serviceable hearing that were offered ELSD. Patients randomized into two groups, with control group (n = 17) undergone ELSD without steroid injection and experimental group undergone ELSD with steroid injection (n = 18) MAIN OUTCOME MEASURE(S):: Audiogram, dizziness handicap inventory, tinnitus handicap inventory, frequency of vertigo spells, functional level scale, and quality of life were obtained at multiple intervals from preoperatively to 24 months postoperatively. ELSD resulted in a statistically significant improvement in vertigo control whether or not steroid was injected into the endolymphatic sac at the time of surgery. However, no additional benefit was observed with the addition of intra-sac steroid injection. No statistical difference in pure-tone average, tinnitus handicap inventory, dizziness handicap inventory, or quality of life was observed between the steroid and nonsteroid surgical groups up to 24 months postoperatively. ELSD is an effective treatment for Menière's disease refractory to medical therapy; however, the addition of intra-sac steroid injection at the time of surgery does not seem to result in a further improvement in patient outcomes.

Meniere's disease.

Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.

Comparison the results of two different vestibular system surgery in patients with persistent Meniere's disease.

Background:Incidence rates of Meniere's disease vary considerably from 157/100,000 in the United Kingdom to 15/100,000 in the United States. Furthermore, in Iran prevalence of Meniere's disease is high, whereas we have not a reliable statistical study on it. A wide range of treatments are used for the treatment of the condition with no consensus on the most effective intervention. The aim of the present study, which involved 37 patients treated because of severe vertigo due to persistent Meniere's disease from 1996 to 2011, was to compare the effectiveness of two surgical methods cochleosacculotomy and endolymphatic sac decompression on vertigo and tinnitus.Materials and Methods:In a cross-sectional study, we compared two surgical approaches in patients with Meniere's disease who did not respond to usual medical treatment. Twenty-three patients underwent cochleosacculotomy surgery and 14 patients endolymphatic sac decompression surgery. We compared all the patients for resolving of vertigo, tinnitus.Results:After surgery, in patients of both group vertigo was improved significantly (P < 0.0001), tinnitus was improved, but it was not significant (P > 0.05) and hearing level was worse than before (especially in patients who had undergone cochleosacculotomy) (P < 0.0001).Conclusion:Based on the data of the current study, cochleosacculotomy and endolymphatic sac decompression improved vertigo in patients with persistent Meniere's disease.

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

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 &gt; .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 &lt; .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.

Does endolymphatic sac decompression surgery prevent bilateral development of unilateral Ménière disease?

The aim of the study was to elucidate whether endolymphatic sac decompression surgery (ESDS) has the potential to prevent unilateral Ménière disease (MD) from becoming bilateral. Prospective case-control study at tertiary referral center. Between 1996 and 2008, we performed a glycerol test (G-test) and electrocochleography (ECoG) on 237 patients with intractable unilateral MD. We performed ESDS on 179 patients (144 with no 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. Altogether, 22.4% (53 of 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, six of 40 patients with unilateral MD with no endolymphatic hydrops in the contralateral ear developed bilateral disease, whereas in the surgical group 12 of 144 patients did so (P = .231, Fisher test). In the nonsurgical group, nine of 18 patients with unilateral MD and silent endolymphatic hydrops developed the disease in the contralateral ear, whereas in the surgical group six of 35 patients developed bilateral disease (P = .022, Fisher test). The present findings suggest that ESDS may decrease the incidence of developing MD in silent endolymphatic hydronic contralateral ears diagnosed with G-test and ECoG within the first 5 postoperative years.

Effects of endolymphatic sac decompression surgery on endolymphatic hydrops

Conclusions: The present findings suggest that complete control of vertigo after endolymphatic sac decompression surgery (ESDS) does not always depend on improved vestibular function or reduced endolymphatic hydrops. Vertigo control is, however, associated with hearing stability.Objective: Among surgical treatments for intractable Meniere’s disease, ESDS is performed to preserve and improve inner ear function. We examined the correlation between changes in vertigo frequency and neuro-otologic function to understand the condition of the inner ear in patients whose vertigo was completely controlled after undergoing ESDS.Methods: This was a retrospective cross-tabulation study. Between 1997 and 2001, we treated 52 patients with intractable vertigo using ESDS and followed the patients regularly for 2 years. Postoperatively we evaluated and recorded changes in vertigo attack frequency, maximum slow phase eye velocity, worst hearing level, and glycerol test results according to modified American Academy of Otolaryngology–Head and Neck Surgery 1995 criteria.Results: We found no correlation between vertigo control and vestibular function. There was also no correlation between vertigo control and negative conversion of the glycerol test. There was a significant correlation between vertigo control and hearing control .

Sac-vein decompression for intractable Meniere's disease: Two-year treatment results

Surgical intervention has been offered to patients with Meniere's disease who have failed medical treatment and have disabling symptoms. Surgical options have included labyrinthectomy (mechanical and chemical), vestibular neurectomy, and endolymphatic sac surgery with or without shunting. We present a modification of endolymphatic sac decompression surgery that includes wide decompression of the sigmoid sinus, posterior cranial fossa dura, and endolymphatic sac (sac-vein decompression). Thirty-five patients underwent 37 primary procedures with 2 years of follow-up. Patients were evaluated according to the 1985 American Academy of Otolaryngology–Head and Neck Surgery criteria for assessing Meniere's disease. Vestibular symptom severity was resolved or mild in 92% and disability severity was none or mild in 95% of patients at 2 years after surgery. Vertigo control was complete or substantial in 85% and 100% of patients at 1 and 2 years after surgery. Audiologic data showed stable or improved hearing in 86% and 85% of patients at 1 and 2 years after surgery. In summary, wide decompression of the sigmoid sinus, posterior cranial fossa dura, and endolymphatic sac offers improved control of vertigo and hearing stabilization for intractable Meniere's disease compared with simple endolymphatic sac decompression or shunt surgery. (Otolaryngol Head Neck Surg 1998;118:22-9.)

Therapeutic Options in Meniere's Disease

Emphasis on treatment in Meniere's disease has recently shifted from a concentration on the vertiginous component alone to include conservation or improvement of hearing as well. This presentation tabulates the current otological literature's reports of both the medical and surgical options available in the treatment of Meniere's disease. The authors conclude that these more recent reports deemphasize the importance of the vertiginous component, while emphasizing the importance of the hearing component in evaluation of the efficacy of any therapeutic modality. Furthermore, these reports indicate that endolymphatic sac decompression and drainage surgery alone offers a considerable chance for conservation or improvement in hearing, as well as relief of vertigo in early cases of reversible, fluctuating hearing deficits. In nonreversible or nonfluctuating hearing deficits with hearing worth conserving, vestibular neurectomy with excision of Scarpa's ganglion yields the best results.