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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
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.
Otol Neurotol
35:
1033
Y
1045, 2014.
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
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
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.eduThe authors disclose no conflicts of interest.
Supplemental digital content is available in the text.
Otology & Neurotology
35:
1033
Y
1045 2014, Otology & Neurotology, Inc.
Reprinted by permission of Otol Neurotol. 2014; 35(6):1033-1045.
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