Long-term results of endolymphatic sac drainage with local steroids for intractable Meniere's disease
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Tadashi Kitahara1, Munehisa Fukushima, Atsuhiko Uno
1Department of Otolaryngology-Head and Neck Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan. tkitahara@ent.med.osaka-u.ac.jp
Objectives:
Meniere's disease is a common inner ear disease characterized by vertigo, hearing loss and tinnitus. Since Meniere's disease is thought to be triggered by an immune insult to inner ear hydrops, we examined endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids for intractable Meniere's patients and observed long-term results from 2 years to over a decade until 13 years.
Methods:
Between 1998 and 2009, we enrolled and assigned 286 intractable Meniere's patients to two groups: group-I (G-I) included patients who underwent endolymphatic sac drainage with steroid instillation and group-II (G-II) included those who declined endolymphatic sac drainage. Definitive spells and hearing improvement in these two groups were determined for 2-13 years after treatment.
Results:
According to the established criteria, vertigo was completely controlled in 88% of patients in G-I in the 2nd year, in 73% in the 12th year and in 70% in the 13th year. These results in G-I were significantly better than those in G-II for 13 years after treatment. Hearing was improved in 49% of patients in G-I in the 2nd year, in 27% in the 12th year and in 25% in the 13th year. These results in G-I were significantly better than those in G-II for 12 years after treatment, but this was not significant in the 13th year.
Conclusions:
Endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids could improve long-term follow-up results of hearing as well as vertigo control. This means that the drainage with local steroids could also improve patients' long-term quality in the prime of life.
Insights
Endolymphatic sac drainage with steroids effectively controlled vertigo and improved hearing in Meniere's disease patients long-term. This treatment offers significant benefits for managing intractable symptoms and enhancing quality of life.
Area of Science:
- Otolaryngology
- Neurology
- Immunology
Background:
- Meniere's disease is an inner ear disorder causing vertigo, hearing loss, and tinnitus.
- It's hypothesized to stem from immune-mediated inner ear hydrops.
- Intractable cases require effective long-term management strategies.
Purpose of the Study:
- To evaluate the long-term efficacy of endolymphatic sac drainage with intra-endolymphatic sac steroid application.
- To assess outcomes in patients with intractable Meniere's disease over 2 to 13 years.
Main Methods:
- A cohort of 286 intractable Meniere's disease patients was studied from 1998-2009.
- Group I underwent endolymphatic sac drainage with steroid instillation.
- Group II (control) declined the procedure; outcomes were compared over 2-13 years.
Main Results:
- Vertigo control in Group I was 88% (2 yrs), 73% (12 yrs), and 70% (13 yrs), significantly better than Group II.
- Hearing improvement in Group I was 49% (2 yrs), 27% (12 yrs), and 25% (13 yrs), significantly better than Group II for 12 years.
Conclusions:
- Endolymphatic sac drainage combined with localized steroid application provides sustained vertigo control and hearing improvement.
- This therapeutic approach enhances long-term quality of life for Meniere's disease patients.
