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In this single centre retrospective study, the authors applied semicircular canal plugging, well known as a treatment for refractory BPPV, to intractable unilateral Meniere’s disease (MD) that had failed to respond to medical treatment with betahistine and hydrochlorothiazide. However, in MD all three semicircular canals were plugged (triple semicircular canal plugging – TSCP). Failure of medical treatment was defined as at least two attacks per month for at least six months. Included in the study were 361 patients with definite unilateral MD. Over a study period of five years, 75 MD patients treated with intratympanic gentamicin served as controls. Patient in both groups had no serviceable hearing (PTA average >60dB and SRT <50dB). Pure tone audiometry, caloric test and VEMPs were performed at baseline and at two years of follow-up. The main outcome measures were vertigo control and auditory function. The frequency of vertigo six months before TSCP and between 18-24 months post-surgery was used to judge vertigo control. At 24 months, vertigo control (complete and substantial) was statistically significantly better in the TSCP group compared with controls (97.8% vs. 80%; p <0.05). Deterioration in auditory function was equal in both groups (26% vs. 25%). As expected, vestibular function deteriorated in both groups. Of note, caloric canal paresis was seen in 60% of the surgical group at baseline but was 100% at 24 months. VEMP parameters did not change significantly pre- and post-op, leading to the conclusion that vestibular hair cell loss was minimal, an advantage of TSCP over gentamicin. Postoperatively, all patients had vertigo, imbalance and spontaneous nystagmus. Vertigo resolved by day five and by day 15 the imbalance had resolved, as opposed to about 30 days following labyrinthectomy or vestibular neurectomy. The cause of hearing loss after TSCP was not clear but the authors suggested the possibility of serous fibrous labyrinthitis or perilymphorrhoea. The long-term control of vertigo is certainly a positive outcome of TSCP but the suggestion that it is less destructive than intratympanic gentamicin is debatable. There was no mention of any the need for vestibular rehabilitation post-treatment or whether there was any contact with the patients between the initial treatment and at 24 months. In any case, TSCP is another treatment worth considering for intractable MD.

Long-term outcomes of triple semicircular canal plugging for the treatment of intractable Meniere’s disease: A single centre experience of 361 cases.
Zhang D, Lv Y, Han Y, et al.
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Victor Osei-Lah

Bournemouth, UK.

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