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Industry: Email Alert RSS FeedDelayed endolymphatic hydrops: Study and review of clinical implications and surgical treatment - Brief Article
Ear, Nose & Throat Journal, Feb, 2001 by Tsun-Sheng Huang, Ching-Chen Lin
Among patients with intractable Meniere's disease, the success rate of ELS surgery has been reported to range from approximately 70 to 95% for relieving vertigo and approximately 60 to 90% for improving and sustaining hearing. [12-25,21,29] Meanwhile, the incidence of surgical anacusis is less than 2%. In this context, it is worth noting that the incidence of anacusis following ELS surgery is marginally higher when endolymph is drained from the duct than from the sac. [15] Although there was no cochlear function damage observed in our series, it appears that endolymphatic duct procedures with intraductal capillary devices are best avoided--or at least performed cautiously--in patients with contralateral DEH in order to avoid adverse or catastrophic effects on inner ear function. It is interesting to note that promising results have been achieved with a drainage method (endolymphatic sac balloon surgery) devised by the primary author (T.S.H.). [30] This technique involves opening the endolymphatic sac and exp anding its lumen by inserting a Silastic ribbon sheet that is fan-folded within the sac.
The chances of achieving long-term vertigo control are greater with vestibular nerve section than with ELS surgery. [29,3] However, vestibular nerve section is difficult to perform and carries a higher risk of compromising inner ear function ([greater than]10% anacusis) and morbidity. (Even so, Silverstein et al reported that none of their cases suffered total hearing loss. [32]) Therefore, ELS surgery remains the procedure of choice in the only-hearing or better-hearing ear in patients with contralateral DEH.
If symptoms recur, revision sac surgery can be as effective as primary ELS surgery. Paparella and Sajjadi [33] reported that revision sac surgery not only eliminated vertigo, it greatly improved hearing in some cases, a finding that paralleled our own. [34] Paparella and Sajjadi also noted that the effectiveness of this revision procedure was similar to that of the primary operation.
A newer procedure was recently developed that involves the use of the Round Window micro-Cath (IntraEar Corp.; Cupertino, Calif.). This perfusion device is equipped with a micropump that provides a continuous delivery of minute, controllable amounts of gentamicin. Absorption is maximized by allowing the gentamicin to permeate through the round window membrane and into the inner ear. This technique provides adequate gentamicin toxicity to the vestibular receptor while sparing cochlear function. Our experience with this procedure in controlling vertigo while preserving hearing have been very positive.
From the Department of Otolaryngology, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan.
Reprint requests: Tsun-Sheng Huang, MD, Department of Otolaryngology, Chang Gung Memorial Hospital, 199 Tun-Hwa North Rd., Taipei, Taiwan 105. Phone: +886-2-2713-5211; fax: +886-2-2719-3658; e-mail: huang571@ms23.hinet.net
References
(1.) Nadol JB Jr., Weiss AD, Parker SW, Vertigo of delayed onset after sudden deafness. Ann Otol Rhinol Laryngol 1975;84:841-6.
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