Endolymphatic sac drainage and steroid-instillation surgery for intractable Meniere's disease

DOI
  • Kitahara Tadashi
    Department of Otolaryngology & Head and Neck Surgery, Osaka University Graduate School of Medicine

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Other Title
  • 当施設における内リンパ嚢高濃度ステロイド挿入術

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Description

Meniere's disease is a common inner ear disease with an incidence of 15-50 per 100,000 population. Since Meniere's disease is thought to be triggered by an immune insult to inner ear, we examined intra-endolymphatic sac application of large doses of steroids as de novo treatment for intractable Meniere's disease. <br>The technical details of endolymphatic sac drainage with steroid-instillation are as follows: A simple mastoidectomy was performed, clearly exposing the endolymphatic sac in the area between the sigmoid sinus and the inferior margin of the posterior semicircular canal. If possible, the sac was exposed including the rugose portion. The sac was opened with an L- (right ear) or backward L- (left ear) shaped incision made along the posterior and distal margins of the lateral wall. Then the sac was filled with a mass of 20 mg of prednisolone. While dissolving the mass in the sac, we prepared a bundle of absorbable gelatin films (ca. 4×20×0.7mm×5sheets) with fan- and stick-shaped ends. These films were tied to each other with biochemical adhesive (human thrombin combined with human fibrinogen) at the stick-shaped end. The fan-shaped end was then inserted into the sac and small pieces of absorbable gelatin sponge soaked in a high concentration of dexamethasone (32mg/4ml) were placed inside and outside the sac lumen expanded with the bundle. The sponges containing dexamethasone placed outside the sac were coated with the adhesive so that dexamethasone was slowly delivered into the sac over a long period of time as a natural sustained-release vehicle. The stickshaped end extending out of the sac was fixed to the front edge of the mastoid cavity with the same adhesive so that the incision into the sac was also expanded as long as possible. The mastoid cavity was filled with relatively large pieces of absorbable gelatin sponge dipped in steroid antibiotic solution, after which the wound was closed with skin sutures.

Journal

  • Otology Japan

    Otology Japan 24 (1), 49-52, 2014

    Japan Otological Society

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