77 / 264
1) ‘‘endolymphatic sac surgery for Me´nie`re’s disease’’; 2)
‘‘endolymphatic sac surgery’’; 3) ‘‘surgery for Me´nie`re’s dis-
ease’’; 4) MeSH ‘‘Me´nie`re’s disease/surgery.’’ This resulted in a
total of 4,262 abstracts and manuscripts that were subjected to our
inclusion and exclusion criteria (Fig. 1A). Our search is graphi-
cally depicted in an algorithmic format (Fig. 1B).
Endpoints
Primary endpoint defined as postoperative vertigo control was
evaluated using the AAO-HNS guidelines (1,2). Categories A/B
were grouped together and represented either ‘‘complete vertigo
control’’ or ‘‘substantial vertigo control.’’ These categories were
combined because Category B is generally viewed as a success
as it represents a substantial reduction (99%
Y
60%) in vertigi-
nous attacks. Also, patients with Category B vertigo control
typically report great improvement in quality of life and func-
tional level (29).
Secondary endpoint defined as postoperative hearing preser-
vation was evaluated using the AAO-HNS guidelines (1,2). Mean
pure-tone audiometry (PTA) threshold changes were calculated
and were categorized either as ‘‘improved’’/‘‘stable’’ (postoper-
ative thresholds within 10 dB of preoperative levels) or ‘‘wors-
ened’’ (postoperative levels
9
10 dB of preoperative levels).
Further, weighted mean PTA
$
dB (500, 1,000, and 2,000 Hz)
was calculated for each ESS subtype.
Both primary and secondary endpoints were evaluated for
short-term and long-term results, defined as more than 12 and
more than 24 months of follow-up, respectively.
Data Extraction
Data from studies meeting inclusion and exclusion criteria
were extracted and verified by a second author. Information
extracted from each study included author, year of publication,
number of patients studied, mean length of follow-up, and any
reported preoperative and postoperative outcomes.
FIG. 2.
Vertigo control: Forest plot for endolymphatic sac de-
compression with Category A/B vertigo control at a minimum of
12 months of follow-up.
FIG. 3.
Hearing outcomes: Forest plot for endolymphatic sac
decompression with hearing improved or stable at a minimum of
12 months of follow-up.
FIG. 4.
Vertigo control: Forest plot for mastoid shunt (including
both
with
and
without
silastic sheeting) with Category A/B vertigo
control at a minimum of 12 months of follow-up. +ss indicates with
silastic sheeting;
j
ss, without silastic sheeting.
FIG. 5.
Hearing outcomes: Forest plot for mastoid shunt (including
both
with
and
without
silastic sheeting) with hearing improved or
stable at a minimum of 12 months of follow-up.
ENDOLYMPHATIC SAC SURGERY FOR ME´ NIE` RE
_
S DISEASE
Otology & Neurotology, Vol. 35, No. 6, 2014
56