Jennifer L Spiegel1,2, Ivelina Stoycheva3,4, Bernhard G Weiss3, Mattis Bertlich3,5, Tobias Rader3, Martin Canis3, Friedrich Ihler3,6. 1. Department for Otorhinolaryngology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany. jennifer.spiegel@med.uni-muenchen.de. 2. German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany. jennifer.spiegel@med.uni-muenchen.de. 3. Department for Otorhinolaryngology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany. 4. Department of Ear, Nose, Throat, Head and Neck Surgery, Asklepios Kliniken Bad Tölz, Schützenstraße 15, 83646, Bad Tölz, Germany. 5. Department of Dermatology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany. 6. German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany.
Abstract
PURPOSE: Treatment of Menière's Disease (MD) comprises an array of both non-destructive and destructive treatment options. In patients who are therapy-refractory to non-destructive medical treatment, endolymphatic mastoid shunt surgery (EMSS) is both recommended and debated controversially. The aim of this study was to investigate safety in terms of hearing, vestibular function, complication rate, and efficacy with regards to vertigo control of EMSS in patients with MD according to the current diagnostic criteria of 2015. METHODS: Retrospective analysis of 47 consecutive patients with definite or probable MD with description of demographic parameters, pre- and postoperative MD treatment, pre- and postoperative audiometric (pure tone audiometry) and vestibular (caloric testing) results. The parameters were compared between patients with and without postoperative vertigo control. RESULTS: 31/47 patients (66.0%) had improved vertigo control postoperatively. Postoperative hearing and vestibular preservation were predominantly stable. No significant differences between patients with improved vertigo control and patients with no change or worse vertigo episodes were found. In the treatment refractory group, 4 patients required a revision EMSS and 6 a destructive MD treatment (5 gentamicin intratympanically, 1 labyrinthectomy). No peri- or postsurgical complications were reported. CONCLUSIONS: EMSS was found to be beneficial in two thirds of the patients with definite or probable Morbus Menière and a safe procedure regarding hearing and vestibular preservation with no postoperative complications. Therefore, EMSS should be considered before inducing destructive treatment options, such as intratympanic gentamicin application or labyrinthectomy.
PURPOSE: Treatment of Menière's Disease (MD) comprises an array of both non-destructive and destructive treatment options. In patients who are therapy-refractory to non-destructive medical treatment, endolymphatic mastoid shunt surgery (EMSS) is both recommended and debated controversially. The aim of this study was to investigate safety in terms of hearing, vestibular function, complication rate, and efficacy with regards to vertigo control of EMSS in patients with MD according to the current diagnostic criteria of 2015. METHODS: Retrospective analysis of 47 consecutive patients with definite or probable MD with description of demographic parameters, pre- and postoperative MD treatment, pre- and postoperative audiometric (pure tone audiometry) and vestibular (caloric testing) results. The parameters were compared between patients with and without postoperative vertigo control. RESULTS: 31/47 patients (66.0%) had improved vertigo control postoperatively. Postoperative hearing and vestibular preservation were predominantly stable. No significant differences between patients with improved vertigo control and patients with no change or worse vertigo episodes were found. In the treatment refractory group, 4 patients required a revision EMSS and 6 a destructive MD treatment (5 gentamicin intratympanically, 1 labyrinthectomy). No peri- or postsurgical complications were reported. CONCLUSIONS: EMSS was found to be beneficial in two thirds of the patients with definite or probable Morbus Menière and a safe procedure regarding hearing and vestibular preservation with no postoperative complications. Therefore, EMSS should be considered before inducing destructive treatment options, such as intratympanic gentamicin application or labyrinthectomy.
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