Endolymphatic sac-mastoid shunt surgery. A nonspecific treatment modality?

The reason for the effectiveness of endolymphatic sac-mastoid shunt surgery in the treatment of patients with Meniere's disease is still open for debate. In a double-blind study, published in 1981, we could not demonstrate any difference between the effect of a simple mastoidectomy and a regular endolymphatic sac-mastoid Silastic sheet shunt. However, a significant reduction in symptoms could be demonstrated in both groups, and 70% of patients in both groups could be classified as successes. The patients were reexamined 3 years after surgery, and it was still not possible to demonstrate any differences between the sham and the active surgery. In this study, no significant differences between the two groups have been found at follow-up averaging 84 months, and success has been maintained in about 70% of patients. The only three failures, who have consistent vertiginous attacks, have been confined to the actual shunt group. Two patients in the active group have lost their hearing as compared with none in the sham group, and 35% of the patients have now developed bilateral disease. We believe that endolymphatic sac-mastoid shunt surgery is a nonspecific treatment modality, and we find no need for sac shunt surgery. The vast majority of the patients can be successfully treated by nonsurgical means, but we emphasize that above all the patient must be assured that in the event of persistent debilitating symptoms, a surgical solution to the problem is available.