HSC Section 8_April 2017

evidence points toward the endolymphatic sac contributing

to the etiopathophysiology of MD.

Short-term Analysis

Decompression

The first successful human endolymphatic sac de-

compression procedure was performed in France in 1926

(9,10), before Hallpike and Cairns’ microscopic studies

and description of labyrinthine hydrops (9,69). Since

then, decompression has generally been viewed as a safe

surgical option because it does not significantly impact

hearing (8,49). The theory behind decompression is that

removal of mastoid bone provides pressure relief and

allows for expansion of the endolymphatic sac, thereby

decreasing episodic vertigo attacks (8,70). Despite the

safety and low morbidity of sac decompression, its effi-

cacy in controlling vertiginous attacks of MD has been

debated with great inconsistency. Some studies endorse

94% to 100% improvement (Category A/B) (13,17

19),

while others state 60% to 64% (16,21).

In our analysis, 79.3% of patients undergoing endo-

lymphatic sac decompression achieved complete or sub-

stantial (Category A/B) vertigo control with a minimum

FIG. 18.

Vertigo control: Forest plot for current endolymphatic sac procedures (i.e., sac decompression and mastoid shunt

with

and

without

silastic

in studies with short-term and long-term follow-up), short-term follow-up Category A/B vertigo control. Mean weighted follow-up was at

16 months. EMS indicates mastoid shunt; ESD, sac decompression.

FIG. 19.

Vertigo control: Forest plot for current endolymphatic sac procedures (i.e., sac decompression and mastoid shunt

with

and

without

silastic

), long-term follow-up Category A/B vertigo control. Mean weighted follow-up was at 79.0 months. EMS indicates mastoid shunt; ESD,

sac decompression.

ENDOLYMPHATIC SAC SURGERY FOR ME´ NIE` RE

S DISEASE

Otology & Neurotology, Vol. 35, No. 6, 2014