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The effect of surgical removal of the extraosseous portion of the endolymphatic sac in patients suffering from Menière's disease

Published online by Cambridge University Press:  29 June 2007

William P. R. Gibson*
Affiliation:
Department of Surgery. The University of Sydney, Sydney. Australia
*
Address for correspondence: Professor W. P. R. Gibson, Department of Surgery, University of Sydney, Sydney 2006, Australia.

Abstract

Between April 1990 and June 1996, the extraosseous portion of endolymphatic sac has been removed from the affected ear in 77 patients suffering from Menière's disease. Removal of the extraosseous part of the endolymphatic sac without any drainage procedure did not increase the frequency or severity of the attacks of vertigo in any patient. The results of 43 patients with unilateral disease who had a follow-up period of two years are presented. Only eight of the patients had more than two recurrent attacks of vertigo lasting over two minutes within the two years after the surgery, and in three of these patients the severity of the attacks was greatly reduced. In 56 per cent of the operated ears, the hearing deteriorated at least 10 dBHL across five audiometric frequencies (250 Hz, 500 Hz. 1 kHz. 2 kHz and 3 kHz). To the author, endolymphatic sac removal appeared to provide better relief from vertigo than a simple drainage procedure with less tendency for recurrence several months or years after the initial surgery. At present, the statistical analysis of the results shows no significant difference between removal of the extraosseous portion of the endolymphatic sac and the ‘so called’ endolymphatic sac drainage procedures.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 1996

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References

Arenberg, I. K., Rask-Andersen, H., Wilbrand, H., Stahle, J. (1977) The surgical anatomy of the endolymphatic sac. Archives of Otolaryngology 103: 111.CrossRefGoogle ScholarPubMed
Bagger-Sjöbäck, D., Jansson, B., Friberg, U., Rask-Andersen, H. (1990) Three dimensional anatomy of the human endolymphatic sac. Archives of Otolaryngology 116: 345349.CrossRefGoogle ScholarPubMed
Fraysse, B. G., Alonso, A., House, W. F. (1980) Menière's disease and endolymphatic hydrops. Clinical-histopathological correlations. Annals of Otology, Rhinology and Laryngology (Suppl 76): 222.CrossRefGoogle ScholarPubMed
Friberg, U., Jansson, B., Rask-Andersen, H., Bagger-Sjoback, D. (1988) Variations in surgical anatomy of the endolymphatic sac. Archives of Otolaryngology 114: 389394.CrossRefGoogle ScholarPubMed
Gibson, W. P. R. (1991) The 10-point score for the clinical diagnosis of Menière's disease. In Surgery of the Inner Ear. (Arenberg, I. K., ed.) Kugler Publications, Amsterdam, pp 109.Google Scholar
Gibson, W. P. R. (1993) The scope of intraoperative electrocochleography. In ECOG, OAE and intraoperative Monitoring. (Höhmann, D., ed.) Kugler Publications, Amsterdam, pp 121123.Google Scholar
Gibson, W. P. R., Arenberg, I. K. (1991) A new theory of the attacks of vertigo in Menière's disease. In Surgery of the Inner Ear. (Arenbeg, I. K., ed.) Kugler Publications, Amsterdam, pp 1722.Google Scholar
Harris, J. P., Tomiyama, S. (1987) The role of the endolymphatic sac in inner ear immunity. Acta Otolaryngologica 103: 182188.Google Scholar
Lundquist, P.-G. (1976) Aspects on endolymphatic sac morphology and function. Archives of Otolaryngology 212: 231240.Google ScholarPubMed
Lundquist, P.-G., Kimura, R., Wersall, J. (1964) Ultrastructural organisation of the epithelial lining of the endolymphatic duct and sac in the guinea pig. Acta Otolaryngologica 57: 6580.CrossRefGoogle ScholarPubMed
Monsell, E. M., Balkany, T. M., Gates, G. A., Goldberg, R. A., Meyerhoff, W. A., House, J. W. (1995) Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Menière's disease. Otolaryngology, Head and Neck Surgery 113: 181185.Google Scholar
Monsell, E. M., Weit, R. (1988) Endolymphatic sac surgery: methods of study and results. American Journal of Otology 9: 396402.Google ScholarPubMed
Rask-Andersen, H. (1991) Personal communication.Google Scholar
Rask-Andersen, H., Danckwardt-Lilliestrom, N., Linthicum, F. H., House, W. F. (1991) Ultrastructural evidence of a merocrine secretion in the human endolymphatic sac. Annals of Otology, Rhinology and Laryngology 100: 148156.CrossRefGoogle ScholarPubMed
Schuknecht, H. F. (1976) The pathophysiology of endolymphatic hydrops. Archives of Otology, Rhinology and Laryngology 212: 253262.CrossRefGoogle ScholarPubMed
Schuknecht, H. F. (1968) Correlation of pathology with symptoms of Menière's disease. Otolaryngologic Clinics of North America 1: 433438.CrossRefGoogle Scholar
Shea, J. J. (1993) Classification of Menière's disease. American Journal of Otology 14: 224229.Google ScholarPubMed
Stahle, J., Friberg, U., Svedberg, A. (1991) Long-term progression of Menière's disease. Acta Otolaryngologica (Suppl 485): 7883.CrossRefGoogle ScholarPubMed
Sterkers, O., Ferray, E., Arniel, C. (1984) Inter and intracompartmental osmotic gradients within the rat cochlea. American Journal of Physiology 247: F602F606.Google ScholarPubMed
Wackym, P. A., Friberg, U., Bagger-Sjöbäck, D., Linthicum, F. H., Rask-Andersen, H. (1987) Human endolymphatic ac: possible mechanisms of pressure regulation. Journal of Laryngology and Otology 101: 768779.CrossRefGoogle Scholar
Welling, D. B., Pasha, R., Roth, L. J., Barin, K. (1996) The effect of endolymphatic sac excision in Menière's disease. American Journal of Otology 17: 278282.Google Scholar