This is a very useful meta-analysis for those that perform surgery for Ménière’s disease. It specifically looked at differences in various forms of endolymphatic sac surgery (ESS). A total of 36 papers were included. The results: ESS controls vertigo in the short-term (>1 year) in 75% of cases who haven’t had trial of intratympanic treatment. Long-term control drops to 63% (6.5 years follow-up). There is no difference between sac decompression (removing bone over the sac) and mastoid shunting (also inserting silastic into the sac to allow drainage), procedures for vertigo, however there is probable 6dB worsening of hearing with shunting procedures rather than just decompression. Interestingly, in shunting procedures, there is a greater chance of maintaining hearing if no silastic is used. The recommendation is to open the sac and not to leave in silastic as a stent. It is postulated that silastic causes an immunological reaction within the sac.
Endolymphatic sac surgery for Ménière’s disease
Reviewed by Anand Kasbekar
Endolymphatic sac surgery for Ménière’s disease: a systematic review and meta-analysis.
CONTRIBUTOR
Anand Kasbekar
BMedSci, DOHNS, FRCS (ORL-HNS), DM, Nottingham University Hospitals NHS Trust; Associate, The University of Nottingham; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK.
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