Endolymphatic sac revision for recurrent Menière's disease.

A subset of patients with intractable Menière's disease had a good result for months or years following endolymphatic sac enhancement (ESE), only to develop recurrent symptoms of Menière's disease, including vertigo and deafness. Revision procedures (ESR) revealed extrasaccular fibrosis or granulation tissue, osteoneogenesis, and aditus block syndrome resulting in saccular obstruction and a tight contiguous dura in 26 patients (4% of total ESE patients to date). Following ESR, symptoms and pathologic findings in the main were diminished; in one patient, useful hearing was restored from complete deafness. ESR provides another option for managing these recurrent problems, and most of our patients have continued to do well. This option of therapy, plus a unique opportunity to assess the pathogenesis of Menière's disease in humans will be discussed.