Endolymphatic Duct and Sac Decompression: A New Life for an Old Technique.

BACKGROUND: Ménière's disease is an inner ear disorder causing recurrent vertigo, hearing loss, and tinnitus. Diagnosis is based on the variability of the symptoms over time and absence of radiological abnormalities. Medical therapy is effective only in a small percentage of patients. Surgical strategies remain controversial. In this article, we revisit a surgical technique neglected over the years: endolymphatic sac surgery. METHODS: Fifty-four patients affected by Ménière's disease underwent endolymphatic duct and sac decompression. According to the American Academy of Otolaryngology-Head and Neck Surgery criteria, vertigo control was evaluated with follow-up at 6 months, 1 year, and 2 years from the intervention. Hearing results were evaluated before the surgery and at 2 years of follow-up using the pure tone average. The results were compared with similar techniques of endolymphatic sac surgery described in the literature. RESULTS: According to the American Academy of Otolaryngology-Head and Neck Surgery criteria classification, 2 years after surgery, 87% patients achieved complete control of vertigo (class A). The hearing remained stable in 93.5% of patients. The results appear compatible with other publications data regarding endolymphatic sac surgeries. CONCLUSION: The duct and endolymphatic sac decompression allows the control of vertigo and preserves hearing from the pathological effects of Ménière's disease. The revised technique allows the functional restoration of endolymphatic homeostasis.

Bifenestral surgical and chemical labyrinthectomy, a new effective ablative surgical approach to intractable vertigo in Ménière disease elderly patients / Laberintectomía química y quirúrgica bifenestral, una nueva técnica ablativa eficaz para el vértigo intratable en pacientes ancianos con enfermedad de Ménière

Introduction In this article, the bi-fenestral surgical chemical labyrinthectomy is introduced as a surgical demolition technique for treating resisting incurable forms of Meniere’s disease in patients aged over 70 and/or with low hearing residues refractory to medical treatment. Materials and methods The results on participants fitting the inclusion criteria (n = 16) were reported using anamnesis (frequency of the crisis), Dizziness Handicap Inventory (DHI) and Functional Level Scale (FLS) before and after the intervention. Results Vertigo control was achieved in all patients of this case series. A difference of 57 and 3.67 in mean DHI (from 68 (SD 16.7) to 11 (SD 14)) and FLS (from 4.68 (SD 0.7) to 0.1 (SD 0.3)) scores respectively were seen after an average of 16.28 months. Contextually tinnitus was reported to improve in seven patients (43.75%), aggravate in three (18.75%) and remain unchanged in the remaining six (37.5%). Conclusion Bi-fenestral surgical chemical labyrinthectomy appears a safe, immediate, and effective demolition treatment for vertigo control in a restricted class of patients affected by intractable Meniere disease. (AU)

Introducción En este artículo se presenta la laberintectomía química quirúrgica bifenestral como técnica quirúrgica de demolición para el tratamiento de formas resistentes e incurables de la enfermedad de Meniere en pacientes mayores de 70 años y/o con baja audición refractaria al tratamiento médico. Materiales y métodos Los resultados de los participantes que cumplieron con los criterios de inclusión (n = 16) se informaron mediante anamnesis (frecuencia de las crisis), Dizziness Handicap Inventory (DHI) y Functional Level Scale (FLS) antes y después de la intervención. Resultados Se logró el control del vértigo en todos los pacientes de esta serie de casos. Una diferencia de 57 y 3,67 en las puntuaciones medias de DHI (de 68 (DE 16,7) a 11 (DE 14)) y FLS (de 4,68 (DE 0,7) a 0,1 (DE 0,3)) respectivamente fueron vistos después de un promedio de 16,28 meses. Contextualmente, se informó que el tinnitus mejoró en siete pacientes (43,75%), se agravó en tres (18,75 %) y permaneció sin cambios en los seis restantes (37,5%). Conclusión La laberintectomía química quirúrgica bifenestral parece un tratamiento de demolición seguro, inmediato y efectivo para el control del vértigo en una clase restringida de pacientes afectados por la enfermedad de Meniere intratable. (AU)

Bifenestral surgical and chemical labyrinthectomy, a new effective ablative surgical approach to intractable vertigo in Ménière disease elderly patients.

INTRODUCTION: In this article, the bi-fenestral surgical chemical labyrinthectomy is introduced as a surgical demolition technique for treating resisting incurable forms of Meniere's disease in patients aged over 70 and/or with low hearing residues refractory to medical treatment. MATERIALS AND METHODS: The results on participants fitting the inclusion criteria (n = 16) were reported using anamnesis (frequency of the crisis), Dizziness Handicap Inventory (DHI) and Functional Level Scale (FLS) before and after the intervention. RESULTS: Vertigo control was achieved in all patients of this case series. A difference of 57 and 3.67 in mean DHI (from 68 (SD 16.7) to 11 (SD 14)) and FLS (from 4.68 (SD 0.7) to 0.1 (SD 0.3)) scores respectively were seen after an average of 16.28 months. Contextually tinnitus was reported to improve in seven patients (43.75%), aggravate in three (18.75%) and remain unchanged in the remaining six (37.5%). CONCLUSION: Bi-fenestral surgical chemical labyrinthectomy appears a safe, immediate, and effective demolition treatment for vertigo control in a restricted class of patients affected by intractable Meniere disease.

Endolymphatic duct and sac decompression: A new technique for Ménière's disease treatment.

Background: The present article aims to introduce the endolymphatic duct and sac decompression technique (DASD) and to give a spotlight on its benefits in Ménière's disease (MD) treatment. Methods: Eighty-two patients with intractable MD which met the inclusion criteria were recruited and underwent DASD. This technique allows a meningeal decompression of the duct and the sac from the posterior cranial fossa to the labyrinthine block. The authors considered as main outcomes, the change of the dizziness handicap inventory (DHI) results, with the evaluations of the three sub-scales (Functional scale, Physical scale, and Emotional scale); ear fullness and tinnitus change on the perceptions of the patient; and hearing stage with four-Pure Tone Average (500 hz-1000 hz-2000 hz-4000 hz). The differences between the preoperative and the postoperative score were evaluated. A comparison with the literature was conducted. Results: After a 14-month follow-up, patients that underwent DASD reported a remarkable improvement of the symptoms in all three functional scales, confirmed by the total DHI. The difference between preoperative and postoperative scores is statistically significant. The data describe an ear fullness and tinnitus improvement. The multi-frequency tonal average before and after the surgery does not suggest a worsening of the value for any of 82 patients. Conclusion: The modification of sac surgery includes the endolymphatic duct in the decompression area allowing inner ear functional improvement, vertigo control, ear fullness improvement with minimal risk of facial nerve paralysis, and hearing loss. DASD is an improved old surgical technique.

Minimal invasive resurfacing: an innovative technique for the superior semicircular canal dehiscence. A case series.

The superior semicircular canal dehiscence is a vestibular disease recognized condition in recent years, and surgical therapy has been modeling itself over the years to ensure the control of vestibular symptoms and auditory symptoms. In this case series, the authors have experienced an intervention aimed at closing the superior semicircular canal dehiscence through the insertion of bone paté between the meninx and the residual middle cranial fossa bone wall. Seven patients underwent this intervention, they reported an improvement in all vestibular and auditory symptoms, and hearing threshold remained stable. Despite the small sample size, the difference was significant in the control of dizziness and the reduction of pulsatile tinnitus. The technique described in this article allows the control of symptoms in superior semicircular canal dehiscence, and it is a type of surgery familiar to the otosurgeon and easily replicable as it involves a modified mastoidectomy. More data are needed.