Endolymphatic sac surgery: methods of study and results

Area of Science:

• Otolaryngology
• Neurosurgery
• Vestibular Disorders

Background:

• Meniere's disease is a chronic inner ear disorder characterized by vertigo, hearing loss, and tinnitus.
• Surgery of the endolymphatic sac (ELS) for Meniere's disease has faced scrutiny, leading some surgeons to abandon the procedure.

Purpose of the Study:

• To evaluate the efficacy of endolymphatic sac surgery in managing intractable classical Meniere's disease.
• To assess the impact of ELS surgery on vertigo control and hearing outcomes.

Main Methods:

• Retrospective study of 83 patients with intractable classical Meniere's disease who underwent ELS surgery.
• Evaluation of vertigo control, hearing levels, and patient-reported disability using the American Academy of Otolaryngology--Head and Neck Surgery (AAO-HNS) 1985 reporting method.

Main Results:

• 50% of patients achieved complete freedom from definitive vertigo attacks at 2 years; 25% experienced substantial control.
• 75% of patients reported improvement in their level of disability.
• Vertigo control results were sustained at longer follow-up intervals, though 19% required revision surgery for intractable vertigo.

Conclusions:

• Endolymphatic sac surgery is an effective treatment for controlling disabling vertigo in Meniere's disease, despite its unknown mechanism of action.
• The AAO-HNS 1985 reporting method is superior for evaluating Meniere's disease treatment outcomes, but requires prospective use and clear definitions to avoid confusion.
• While ELS surgery provides significant benefits, careful patient selection and consideration of revision procedures are important for managing persistent symptoms.