Endolymphatic Shunt Surgery in the Era of Intratympanic Gentamycin

Abstract

Objectives:

Report hearing and vertigo outcomes of endolymphatic shunt surgery (ESS) patients with American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) definite Ménière’s disease.

Methods:

We retrospectively reviewed charts of medically intractable Ménière’s patients who underwent ESS at the University of Washington Medical Center. Thirty patients underwent ESS between 2005 and 2012. The surgical outcome was evaluated based on the 1995 guidelines of the American Academy of Otolaryngology—Head and Neck Surgery. Frequency of major vertiginous episodes was measured, and successful control of vertigo is considered as Class A or B (reduced by 60% to 100%). Pure-tone average (PTA; 0.5, 1, 2, and 4 kHz) and word recognition score (WRS) that were obtained before and after treatment are compared.

Results:

Mean age was 46.9 years, and mean follow-up duration was 23.1 months. Mean symptom duration prior to ESS was 5.3 years. Control of vertigo was achieved in 77.8% of the patients at the last follow-up. Seven (25.9%) patients underwent secondary treatment, such as vestibular neurectomy or labyrinthectomy, for definite vertigo control. The mean PTA before and after surgery changed from 43.9 dB to 40.0 dB (P = 0.097), and the mean WRS significantly improved from 68.6% to 77.8% (P = 0.003). Three (10%) patients showed hearing deterioration following treatment.

Conclusions:

Endolymphatic shunt surgery provided successful vertigo control with a low rate of hearing deterioration associated with the surgery. Despite the good results reported by some authors with intratympanic gentamycin, ESS remains a valuable intervention after failure of medical management.