Endolymphatic sac ballooning surgery for Menière's disease.

A newly developed technique (endolymphatic sac ballooning surgery [ESBS]), based on revisional sac surgery observations, was conducted on 135 patients with intractable Meniere's disease. The surgery involves the insertion and fan-folding of a thin Silastic sheet in the endolymphatic sac (ES) lumen to increase its volume. The results of this sac ballooning surgery proved more effective for treatment of incapacitating Meniere's disease symptom complex than did primary ES surgery (ESS) with either the nonballooning sac techniques we employed previously or ESBS revision operations in which primary surgery used nonexpansion techniques. It appears that ESBS, with its preservation of ES integrity and expansion of its lumen, may indeed prevent surgically induced damage and be more efficacious in the drainage of hydropic endolymph. The efficacy of ESS remains controversial because of the failure to understand its pathophysiologic basis. Nevertheless, we are confident that if the ES is definitively delineated, as evidenced by turbid or clear fluid or bubbles when entered, and enlargement of its lumen with maintenance of the sac's integrity is verified during surgery, ESS is undoubtedly efficacious treatment for intractable Meniere's disease. Furthermore, we maintain that equitable judgment may only be rendered when reports evaluating the efficacy of ESS include definitive identification, delineation, and drainage of the sac.