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.

Significance of heterozygosis M34T mutation of GJB2 gene in non-syndromic congenital deafness. Retrospective analysis of 12,472 samples of amniotic fluid.

OBJECTIVE: to determinate the role of heterozygosis of M34T mutation of GJB2 gene in non syndromic congenital deafness. METHODS: retrospective study between March 2010 and June 2013. Molecular screening for 35delG and M34T mutations of the GJB2 gene was offered to all women undergoing to second trimester genetic amniocentesis. Patients were excluded from the study group if one of the following conditions were present: infections, fetal abnormalities, family history for congenital deafness, diagnosis of chromosomal abnormalities, and consanguinity between parents. RESULTS: a total of 12.472 Caucasian women gave informed consent for this test. Seventy-seven cases were excluded. From the 12.395 amniotic fluid analysis remained, the following was found: 2 cases of 35delG homozygosis and 352 cases of heterozygous carriers (42 M34T mutation, 298 35delG mutation, 12 double heterozygosis M34T/35delG). The follow up in first year of life in the 42 newborns with heterozygosis for M34T mutation showed a mild deafness in 23 cases. CONCLUSIONS: in our series, presence of heterozygosis M34T mutation is associated in more than 50% of cases to mild congenital deafness.

Postural variations after breast reduction: introduction of a new technique to achieve an objective analysis.

The authors performed a prospective study to evaluate postural variations arising after reduction mammaplasty, objectively recorded by means of static stabilometry. Thirty consecutive patients affected by various degrees of breast hypertrophy were enrolled in the study. Obesity, orthopedic, and otoneurologic diseases were the exclusion criteria. Postural function was evaluated with static stabilometry preoperatively and 1 and 6 months postoperatively. Patients were grouped according to age, sternal notch-nipple distance, and glandular resection and general and subgroup statistical analysis using Student t test for paired samples were performed. Statistically significant differences were found only after 6 months (P = 0.026). In the subgroup analysis, statistically significant differences were found for the age group >35 years (P = 0.0237) and for the sternal notch-nipple distance >30 cm (P = 0.0320). Stabilometry objectively demonstrated postural improvement perceived following breast reduction. Age and ptosis degree appeared to influence posture more than the entity of resection.

Study of vestibular evoked myogenic potentials in patients affected by Meniere's disease treated with endolymphatic mastoid shunt.

OBJECTIVES: We recorded and compared the vestibular evoked myogenic potentials (VEMPs) before use of an endolymphatic mastoid shunt (EMS) and 1, 12, and 48 months after placement of the shunt. METHODS: Air-conducted VEMPs were recorded in 28 patients affected by intractable Meniere's disease and treated with placement of an EMS. RESULTS: One month and 12 months after the surgery, VEMPs were not detectable in the operated ear in 100% and 86% of the patients, respectively. Forty-eight months after the surgery, they were elicited in 79% of the patients. CONCLUSIONS: We conclude that VEMPs are a clinically useful tool in the postoperative follow-up of patients with an EMS.

The effects of logon versus click on vestibular evoked myogenic potentials.

CONCLUSION: Logon is superior to click to trigger larger and more consistent vestibular evoked myogenic potentials (VEMPs). OBJECTIVES: To record and compare the parameters of VEMPs evoked by bone- and air-conducted logon (l-VEMPs) and click (c-VEMPs). SUBJECTS AND METHODS: Air- and bone-conducted l-VEMPs and c-VEMPs were recorded in 28 normal ears with an Amplaid MK12 (Amplaid, Milan) equipment. RESULTS: VEMPs response rate was 100% with both air-conducted logon and click, while l-VEMPs showed a higher response rate (79%) in comparison with c-VEMPs (21%) with bone-conducted stimuli. A significant (p<0.05) increase of P1, N1 and P1-N1 amplitude and augmented P1 and N1 latencies were noticed in l-VEMPs with respect to c-VEMPs.

Preserved otoacoustic emissions in postparotitis profound unilateral hearing loss: a case report.

We report a case of a profound unilateral sensorineural hearing loss following epidemic parotitis, with good response of otoacoustic emissions. The patient was a 12-year-old girl who had developed a unilateral hearing impairment 2 weeks after the onset of mumps. Pure tone audiometry confirmed a profound left sensorineural hearing loss. The affected ear showed an absence of auditory brain stem responses, whereas transient evoked otoacoustic emissions and distortion product otoacoustic emissions were preserved. Epidemic parotitis virus is likely responsible for an impairment of inner hair cells, primary afferent fibers or their synapses, or a combination of these areas, and it does not seem to have a specific tropism for cochlear outer hair cells. Further follow-up will be necessary to differentiate the present case from auditory neuropathy.

Congenital aplasia of the parotid gland with omolateral cheek angioma: case report and review of the literature.

Congenital agenesis of the parotid gland is a rare entity whose etiopathogenesis is still unclear. It is usually bilateral and is sometimes associated with other developmental anomalies of the head and neck region. A case is presented in which aplasia of the right parotid gland was associated with an omolateral angioma of the cheek. The radiological diagnostic approach and a review of the literature on agenesis of the salivary glands are presented.

Treatment of benign positional vertigo in the elderly: a randomized trial.

OBJECTIVES/HYPOTHESIS: The objective of the study was to evaluate the efficacy of three therapeutic strategies (Semont maneuver, flunarizine, and no treatment) in patients with benign paroxysmal positional vertigo. STUDY DESIGN: Randomized prospective trial. METHODS: One hundred fifty-six consecutive patients older than 60 years of age who were affected by benign paroxysmal positional vertigo of the posterior semicircular canal were enrolled. The diagnosis was made on the basis of the history of recurrent sudden crisis of vertigo and positional-induced typical nystagmus after Dix-Hallpike positioning maneuver. Patients were randomly allocated to receive Semont liberatory maneuver (intended as a statoconia-detachment maneuver), flunarizine, or no treatment. A post-treatment negative Dix-Hallpike test result was considered as a proof of vertigo resolution. RESULTS: Cure rates with Semont maneuver were significantly higher (94.2%) than those obtained with flunarizine (57.7%) and no treatment (36.4%) (P <.001). Within a 6-month follow-up, relapse rates were lower among patients treated with Semont maneuver (3.8%) than those obtained with flunarizine (5.8%) and no treatment (21.1%). All patients with resolution of symptoms and negative Dix-Hallpike test results showed a great improvement in daily activities and quality of life (P <.001). CONCLUSION: Semont liberatory maneuver is the most successful therapy for benign paroxysmal positional vertigo and improves patients' quality of life. Diagnostic and therapeutic maneuvers are easy to perform and should be part of the medical knowledge of every general practitioner and geriatrician.

Stapedoplasty in patients with small air-bone gap: why not?

Otosclerosis is a primary osteodystrophy which affects a localized area within the human temporal bone. Hearing loss is the most functional deficit caused by otosclerosis. However, tinnitus and vestibular disorders are frequently reported by otosclerotic patients, especially in those patients with inner ear involvement. The best therapy in achieving a significant improvement is surgery (stapedoplasty). In most patients if the operation is not carried out for pure middle ear type, the hearing impairment can progress to high-degree hearing loss. Recently, guidelines for the treatment of otosclerosis reported the 20 dbHL threshold as the minimum air-bone gap in performing stapedoplasty. We believe that stapedoplasty is an effective procedure for selected patients affected by otosclerosis with an air-bone gap which is smaller than 20 dbHL. An operation in the earlier phases of the disease can arrest the progression of otosclerosis, preserve inner ear structures and provide a complete auditory recovery, with increased satisfaction of the patient.

Otosclerosis and stapedoplasty in older adults.

OBJECTIVES: To evaluate the efficacy of stapedoplasty in patients aged 60 and older, based on audiometric data and a questionnaire about quality of life. DESIGN: A retrospective (1994-2000) study. SETTING: People living in southern and central Italy. PARTICIPANTS: Sixty-three patients: 32 consecutive patients aged 60 and older (group 1) and 31 consecutive patients younger than 60 (group 2). MEASUREMENTS: In each patient, we evaluated the pre- and postoperative auditory thresholds. Each patient answered a questionnaire about postoperative quality of life. RESULTS: When comparing the pre- and postoperative air conduction thresholds and air-bone gap in the patients aged 60 and older, a statistically significant (P <.001) improvement at each frequency was observed. When elaborating the answers to the questionnaire about postoperative quality of life, we noticed that the older patients experienced a greater improvement. CONCLUSION: The results show that stapedoplasty offers greater improvement in quality of life for selected adults aged 60 and older than for younger adults. The operation also appears to be as safe for adults aged 60 and older as for younger adults. Stapedoplasty provides subjects with satisfactory social hearing level (hearing capacity sufficient for normal social relations) and slows the progression of otosclerosis. Providing older patients with good auditory functionality improves their state of health, quality of life, and cognitive processes.