Endolymphatic sac surgery for Ménière's disease: a systematic review and meta-analysis.

OBJECTIVE: To analyze current endolymphatic surgery techniques and quantify their efficacy in controlling vertigo and maintaining hearing in the short and long term. DATA SOURCES: A comprehensive literature search using the PubMed-NCBI database from 1970 to 2013. STUDY SELECTION: Articles on sac decompression and mastoid shunt (with and without silastic) were included. Included studies had to report data using the 1985 or 1995 American Academy of Otolaryngology-Head and Neck Foundation (AAO-HNS) guidelines, describe surgical technique in detail, include a minimum of 10 patients, and have minimum 12 months of follow-up. DATA EXTRACTION: Endpoints were vertigo control and hearing preservation using AAO-HNS guidelines. Analysis included short-term (>12 mo) and long-term (>24 mo) follow-up. DATA SYNTHESIS: Data analysis was performed using MedCalc 12.7.0. Each article was weighted according to the number of patients treated. Analysis of pooled proportion was performed, and Freeman-Tukey transformation was used to correct for probable variance. A t test (of proportions) was performed to compare differences between groups.
CONCLUSION: 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.