The current status of endolymphatic sac surgery in the treatment of Ménière’s disease

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  • メニエール病治療における内リンパ嚢手術の現状

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<p>Since the first endolymphatic sac surgery (ELS) performed by Portmann in 1926, it has been widely performed to preserve hearing and vestibular function in Ménière’s disease (MD). However, in 1981, Thomsen reported that there was no significant difference between ELS and mastoidectomy performed as placebo suggesting that ELS merely had a placebo effect. Since his report, ELS has been criticized and its use put into question. If the surgery is still to be performed, what factors should be taken into account? In this paper, we discuss the current and future status of ELS that deals with analyzing anatomy as well as the function of the endolymphatic sac (ES); secondly, we cover findings of the ES obtained from patients with MD, and lastly go over ELS outcome based on our own experience, or in published literatures. Compared with cases where no surgery was performed, vertiginous attacks decreased significantly with ELS, and hearing could be preserved in cases with steroid instillation during ELS. In our experience, cases where ELS failed had psychiatric characteristics and in cases where the nystagmus could not be confirmed during a vertiginous attack. Thus, in order to improve ELS results, correct diagnosis of definite cases with MD, and administrating a test that can detect the potential presence of endolymphatic hydrops (EH) are both important. Observation of the presence of EH by MRI should also be considered as an important indicator in the future. For a neurotologist, ELS is a useful alternative for treating refractive cases with MD and is still valuable as a first choice in surgical treatment of MD.</p>

Journal

  • Otology Japan

    Otology Japan 26 (1), 15-19, 2016

    Japan Otological Society

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