HSC Section 8_April 2017

Fig. 1. Treatment of definite Menie` re’s disease. Among 667 patients with definite Menie` re’s disease, 89 (13.3%) patients needed additional intervention to control intractable vertigo despite medical treatment. ELSD (11 patients), application of a Meniett device (3 patients), ITG (78 patients), ETG (1 patient), and labyrinthectomy (1 patient) were carried out. Eight patients still experienced vertigo even after ITG. Five patients got ETG; and vertigo was resolved in four patients and persisted in one, who subsequently underwent labyrinthectomy. Vestibular neurectomy was chosen due to recurrent vertigo in a patient in whom vestibular function was sufficiently attenuated after ITG. The two remaining patients were class C. *Including four patients who suffered from persistent vertigo even after ELSD. † This patient developed chronic draining ear after application of the Meniett device and then underwent ETG during a tympanomastoidec- tomy. ‡ This patient had severe chronic otitis media with severe hearing loss and underwent a labyrinthectomy during a subtotal petrosectomy. ELSD 5 endolymphatic sac decompression; ETG 5 exploratory tympanotomy and gentamicin application; ITG 5 intratympanic gentamicin injection.

such as ETG, labyrinthectomy, and vestibular neurec- tomy were initially considered as second-line treatment options for the patients who failed to achieve improve- ment even after ITG, some cases were carried out just

after the failure of medical management for special rea- sons. A patient developed chronic otitis media with recurrent otorrhea after ventilation tube insertion for the application of the Meniett device and received ETG during the tympanoplasty for chronic otitis media. Another patient with profound mixed hearing loss got labyrinthectomy during a subtotal petrosectomy for chronic suppurative otitis media. Of 113 patients with secondary EH, 96 patients (85.0%) showed improvements with medical management. Seventeen patients (15.0%) needed additional treatment to control intractable vertigo after medical treatment, and all received ITG (Fig. 2). Details about the applied treatment options are summarized in Table I. Vertigo Control After ITG and Its Problems In the 95 patients who received ITG, complete con- trol of vertigo (class A) was achieved in 73 patients (76.8%), and substantial control of vertigo (class B) was achieved in 12 patients (12.6%). Among the 10 patients who suffered from persistent recurrent vertigo, two patients (2.1%) were class C. One patient suffered from persisting vertigo even after four rounds of ITG, and the other patient who received ELSD was not improved

Fig. 2. Treatment flow of secondary endolymphatic hydrops. Among 113 patients, 17 (15.0%) patients needed additional inter- vention to control intractable vertigo despite medical treatment. ETG was tried in a patient; however, vertigo persisted and labyrin- thectomy was carried out subsequently. An incidental intralabyrin- thine schwannoma was found during the labyrinthectomy, and the surgery was completed with a translabyrinthine approach (TL) to check for any residual tumor. ETG 5 exploratory tympanotomy and gentamicin application; ITG 5 intratympanic gentamicin injection.

Laryngoscope 125: April 2015

Rah et al.: Intractable Menie` re’s Disease

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