Long-term results of endolymphatic sac drainage with local steroids for intractable Meniere's disease
- Tadashi Kitahara
, 
, - Munehisa Fukushima,
- Atsuhiko Uno,
- Takao Imai,
- Yumi Ohta,
- Tetsuo Morihana,
- Takefumi Kamakura,
- Arata Horii,
- Hidenori Inohara
- Department of Otolaryngology – Head and Neck Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
Abstract
Objectives
Meniere's
disease is a common inner ear disease characterized by vertigo, hearing
loss and tinnitus.
Since Meniere's disease is thought to be triggered
by an immune insult to inner ear hydrops, we examined endolymphatic sac
drainage with intra-endolymphatic sac application of large doses of
steroids for intractable Meniere's patients and observed long-term
results from 2 years to over a decade until 13 years.
Methods
Between
1998 and 2009, we enrolled and assigned 286 intractable Meniere's
patients to two groups: group-I (G-I) included patients who underwent
endolymphatic sac drainage with steroid instillation and group-II (G-II)
included those who declined endolymphatic sac drainage. Definitive
spells and hearing improvement in these two groups were determined for
2–13 years after treatment.
Results
According
to the established criteria, vertigo was completely controlled in 88%
of patients in G-I in the 2nd year, in 73% in the 12th year and in 70%
in the 13th year. These results in G-I were significantly better than
those in G-II for 13 years after treatment.
Hearing was improved in 49%
of patients in G-I in the 2nd year, in 27% in the 12th year and in 25%
in the 13th year.
These results in G-I were significantly better than
those in G-II for 12 years after treatment, but this was not significant
in the 13th year.
Conclusions
Endolymphatic
sac drainage with intra-endolymphatic sac application of large doses of
steroids could improve long-term follow-up results of hearing as well
as vertigo control.
This means that the drainage with local steroids
could also improve patients’ long-term quality in the prime of life.
Figure from this article:
- Fig. 1. Intra-operative photographs of endolymphatic sac decompression with intra-endolymphatic sac steroids (right ear). (A) The endolymphatic sac was opened with an L-shaped incision made along the posterior and distal margins of the lateral wall. (B) The endolymphatic sac was filled with 20 mg of prednisolone. (C) A bundle of absorbable gelatin films with fan- and stick-shaped ends were prepared and the fan-shaped end was inserted into the sac. (D) Small pieces of absorbable gelatin sponge soaked in a high concentration of dexamethasone were placed inside and outside the sac lumen.Fuente: http://www.sciencedirect.com/science/article/pii/S0385814612002325
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