HSC Section 8_April 2017

Reprinted by permission of Otol Neurotol. 2014; 35(6):1033-1045.

Otology & Neurotology 35: 1033 Y 1045 2014, Otology & Neurotology, Inc.

Endolymphatic Sac Surgery for Me´nie`re’s Disease: A Systematic Review and Meta-analysis

Amit Justin Sood, Paul R. Lambert, Shaun A. Nguyen, and Ted A. Meyer

Department of Otolaryngology Y Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.

Objective: To analyze current endolymphatic surgery techniques and quantify their efficacy in controlling vertigo and maintaining hearing in the short and long term. Data Sources: A comprehensive literature search using the PubMed-NCBI database from 1970 to 2013. Study Selection: Articles on sac decompression and mastoid shunt ( with and without silastic) were included. Included studies had to report data using the 1985 or 1995 American Academy of Otolaryngology Y Head and Neck Foundation (AAO-HNS) guidelines, describe surgical technique in detail, include a mini- mum of 10 patients, and have minimum 12 months of follow-up. Data Extraction: Endpoints were vertigo control and hearing preservation using AAO-HNS guidelines. Analysis included short-term ( 9 12 mo) and long-term ( 9 24 mo) follow-up. Data Synthesis: Data analysis was performed using MedCalc 12.7.0. Each article was weighted according to the number of patients treated. Analysis of pooled proportion was performed, and Freeman Y Tukey transformation was used to correct for First described by French physician Prosper Me´nie`re in 1861, Me´nie`re’s disease (MD) is currently defined as recurrent vertigo, low-frequency sensorinueral hearing loss, and tinnitus with or without the sensation of aural fullness (1,2). Its prevalence has been estimated to range from 3.5 to 513 per 100,000, with the most current esti- mate at approximately 1 per 500, peaking in the fourth to fifth decade of life (3,4); females are more commonly affected than males (3,4). Despite its prevalence, the treatment of MD remains controversial, with multiple medical and surgical options being used. Initial man- agement is typically medical, with dietary modifications, diuretics, and oral steroids. For the 15% to 40% of in- tractable patients, intratympanic injections of steroids or Address correspondence and reprint requests to Paul R. Lambert, M.D., Department of Otolaryngology Y Head and Neck Surgery, Medical Uni- versity of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, U.S.A.; E-mail: lambertp@musc.edu The authors disclose no conflicts of interest. Supplemental digital content is available in the text.

probable variance. A t test (of proportions) was performed to compare differences between groups. Conclusion: Endolymphatic sac surgery (sac decompression or mastoid shunt) is effective at controlling vertigo in the short term ( 9 1 yr of follow-up) and long term ( 9 24 mo) in at least 75% of patients with Me´nie`re’s disease who have failed medical therapy. Sac decompression and mastoid shunting techniques provide similar vertigo control rates. Mastoid shunting, with and without silastic, also provides similar vertigo control rates. Non-use of silastic, however, seems to maintain stable or im- proved hearing in more patients compared to silastic sheet placement. The data suggest that, once the sac is opened, placing silastic does not add benefit and may be deleterious. Key Words: Endolymphatic mastoid shunt V Endolymphatic sac decompression V Endolymphatic sac surgery V Me´nie`re’s disease V Meta-analysis V Systematic review. gentamicin can be considered. Surgical options include endolymphatic sac surgery (ESS), vestibular nerve section, and surgical labyrinthectomy (4 Y 6). Of the surgical op- tions, ESS provides the greatest hearing preservation (7,8). Endolymphatic sac surgery was first described by Portmann in 1923, as he demonstrated its role in pre- serving balance in Selacian fish (9,10). Since Portmann’s initial description, various sac surgery procedures have been devised (11 Y 15). Many view ESS as an effective, nondestructive operation with initial vertigo control rates between 60% and 90% (11 Y 13,16 Y 22). Others, however, question its short-term and long-term efficacy (23 Y 25). Despite intratympanic injections being performed more frequently than ESS over the last decade, ESS is still the most common operative procedure performed for MD in the United States (7,26). Although vertigo control guidelines were created in 1972 (27) and revised in 1985 and 1995 (1,2), reporting of ESS outcomes still remains as subjective as the fluctuating disease process itself. In fact, Thorp et al. (28) demon- strated that, during 1989 to 1999, 79% of otolaryngologists Otol Neurotol 35: 1033 Y 1045, 2014.

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