Endolymphatic Sac Surgery for Ménière’s Disease

Abstract

Endolymphatic sac surgery (sac decompression or mastoid shunt) is effective at controlling vertigo in the short term (>1 yr of follow-up) and long term (>24 mo) in at least 75% of patients with Ménière's disease who have failed medical therapy. Sac decompression and mastoid shunting techniques provide similar vertigo control rates. Mastoid shunting, with and without silastic, also provides similar vertigo control rates. Non-use of silastic, however, seems to maintain stable or improved hearing in more patients compared to silastic sheet placement. The data suggest that, once the sac is opened, placing silastic does not add benefit and may be deleterious.

Neuro-otology- some recent clinical advances

“…Intratympamic dexamethasone might be just as good and should not produce imbalance [56]. A low-sodium diet is traditional [57], endolymphatic sac surgery is controversial [58], drugs such betahistine [59], cinnarizine and dimenhydrinate [60] hopeful.…”

Endolymphatic Sac Surgery for Ménière's Disease – Current Opinion and Literature Review

“…The meta-analysis by Sood et al19 showed a vertigo control in the long term, after approximately 3 years of follow-up, of 81.6% of the patients for sac decompression alone compared to 75.7% for current mastoid shunt techniques. All in categories A and B according to the AAO-HNS classification representing total resolution and great improvement of vertigo respectively 33.…”

“…Overall improvement in vertigo was seen in 90.2% of the patients and an important hearing loss was observed in 25.1% of patients showing that gentamicin is not safe for hearing preservation considering that 1 in every 4 patients will present hearing loss. The meta-analysis by Sood et al19 shows that with endolymphatic sac decompression alone, postoperative hearing was stable or improved in 72.8% of patients and when using mastoid shunts (with and without Silastic) postoperative hearing was stable or improved in 71.4% of them.…”

“…In a systematic review and meta-analysis from 2014 by Sood et al,19 current endolymphatic surgical techniques were analyzed, as well as their efficacy in controlling vertigo and maintaining hearing. This study demonstrated that both procedures, endolymphatic sac decompression alone or with a mastoid shunt, were effective to control vertigo in the short term (between 12 and 24 months of follow-up) and in the long term (> 24 months) in 75% of the patients with Ménière's disease who had no success with medical therapy.…”

Treatment of Meniere’s Disease with Persian Medicine: A Case Report

“…Drug therapy such as cinnarizine, betahistine, etc., and sometimes surgical procedures are commonly used to control the symptoms of the disease. But the disease is recurrent and annoying to the patient (2,3). Therefore, it is considerable to use complementary therapies along with conventional methods to treat this disease.…”