79 / 264
were included in our statistical analysis (12
Y
14,16
Y
22,
25,32
Y
56).
Short-term Analysis
Endolymphatic Sac Decompression Versus
Mastoid Shunt
Endolymphatic Sac Decompression. Vertigo
: Six arti-
cles, totaling 267 patients, were analyzed to determine the
efficacy of endolymphatic sac decompression in control-
ling vertigo. Mean follow-up was 26.2 months (range,
12
Y
55mo). Complete or substantial (Category A/B) vertigo
control was achieved in 79.3% (95% CI, 62.9%
Y
91.9%) of
patients (Fig. 2).
Hearing:
Eight articles, totaling 303 patients, were ana-
lyzed to determine the efficacy of endolymphatic sac de-
compression in hearing preservation. Mean follow-up was
25.8 months (range, 12
Y
55 mo). Postoperative hearing
was stable or improved in 72.8% (95% CI, 62.5%
Y
81.9%)
of patients (Fig. 3). Mean PTA worsened by 1.3 dB
(range,
j
1.4 to 9.6 dB).
Mastoid Shunts (With and Without Silastic). Vertigo
:
Nineteen articles, totaling 1,384 patients, were analyzed to
determine the efficacy of current mastoid shunting pro-
cedures in controlling vertigo symptoms. Mean follow-up
was 31.0 months (range, 12
Y
72 mo). Complete or sub-
stantial (Category A/B) vertigo control was achieved in
76.4% (95% CI, 69.5%
Y
82.7%) of patients (Fig. 4).
Hearing:
Fourteen articles, totaling 799 patients, were an-
alyzed to determine the efficacy of current mastoid shunting
procedures in hearing preservation. Mean follow-up was
34.8 months (range, 12
Y
132 mo). Postoperative hearing
was stable or improved in 71.4% (95% CI, 64.9%
Y
77.5%)
of patients (Fig. 5). Mean PTA worsened by 7.2 dB (range,
0.0
Y
13.3 dB).
Mastoid Shunt With Silastic Versus Mastoid Shunt
without Silastic
Mastoid With Silastic. Vertigo:
Fourteen articles, total-
ing 917 patients, were analyzed to determine the efficacy of
mastoid shunting with silastic sheeting in controlling ver-
tigo. Mean follow-up was 28.3 months (range, 12
Y
51 mo).
Complete or substantial (Category A/B) vertigo control
was achieved in 76.9% (95% CI, 69.1%
Y
83.9%) of pa-
tients (Fig. 6).
Hearing:
Eleven articles, totaling 427 patients, were
analyzed to determine the efficacy of mastoid shunting
with silastic sheeting in hearing preservation. Mean
follow-up was 32.5 months (range, 12
Y
132 mo). Post-
operative hearing was stable or improved in 68.0%
(95% CI, 62.7%
Y
72.1%) of patients (Fig. 7). Mean
PTA worsened by 7.2 dB (range, 0.0
Y
13.3 dB).
Mastoid Without Silastic. Vertigo
: Five articles, total-
ing 467 patients, were analyzed to determine the efficacy
of mastoid shunting without silastic in controlling verti-
go. Mean follow-up was 31.1 months (range, 12
Y
72 mo).
Complete or substantial (Category A/B) vertigo control
was achieved in 75.0% (95% CI, 58.6%
Y
88.5%) of pa-
tients (Fig. 8).
Hearing:
Three articles, totaling 372 patients, were ana-
lyzed to determine the efficacy of mastoid shunting with-
out silastic in hearing preservation. Mean follow-up was
32.6 months (range, 12
Y
72 mo). Postoperative hearing was
unchanged or improved in 72.5% (95% CI, 59.4%
Y
84.9%)
of patients (Fig. 9). Mean PTA worsened by 13.3 dB (only
value, no range).
TABLE 1.
Summary of endolymphatic sac surgery procedures with Category A/B vertigo control in the short term (
9
12 mo)
Procedure
Mean weighted follow-up (mo)
Category A/B vertigo control
Sac decompression
26.2
79.3%
a
,
b
Mastoid shunt (
with
and
ithout
silastic)
31.0
76.4%
a
Mastoid
with
silastic
28.3
76.9%
c
Mastoid
without
silastic
31.1
75.0%
b
,
c
a
Sac decompression versus mastoid shunt (with and without silastic) Category A/B vertigo control;
p
= 0.34.
b
Sac decompression versus mastoid shunt
without
silastic Category A/B vertigo control;
p
= 0.21.
c
Mastoid shunt
with
silastic versus Mastoid shunt
without
silastic Category A/B vertigo control;
p
= 0.47.
TABLE 2.
Summary of endolymphatic sac surgery procedures of hearing preservation in the short term (
9
12 mo)
Procedure
Mean weighted follow-up (mo)
Hearing stable/improved (%)
$
PTA (dB; hearing worsened)
Sac decompression
25.8
72.8%
a
,
b
,
c
1.3
Mastoid shunt (
with
and
without
silastic)
34.8
71.4%
a
7.2
Mastoid
with
silastic
32.5
68.0%
c
,
d
7.2
Mastoid
without
silastic
32.6
72.5%
b
,
d
n/a
a
Sac decompression versus mastoid shunt (with and without silastic) hearing stable/improved;
p
= 0.69.
b
Sac decompression versus mastoid shunt
without
silastic hearing stable/improved;
p
= 0.99.
c
Sac decompression versus mastoid shunt
with
silastic hearing stable/improved;
p
= 0.18.
d
Mastoid shunt
with
silastic versus mastoid shunt
without
silastic hearing stable/improved;
p
= 0.004.
PTA indicates pure-tone audiometry.
ENDOLYMPHATIC SAC SURGERY FOR ME´ NIE` RE
_
S DISEASE
Otology & Neurotology, Vol. 35, No. 6, 2014
58