Changing trends in the surgical treatment of Meniere's disease: Results of a 10-year survey. (Original Article).Abstract In order to discern trends in surgical procedures Surgical procedures have long and possibly daunting names. The meaning of many surgical procedure names can often be understood if the name is broken into parts. For example in splenectomy, "ectomy" is a suffix meaning the removal of a part of the body. "Splene-" means spleen. used to treat Meniere's disease Mé·nière's disease n. A pathological condition of the inner ear that is characterized by dizziness, ringing in the ears, and progressive loss of hearing. Also called auditory vertigo, endolymphatic hydrops, labyrinthine vertigo. in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. during the 1990s, we mailed a questionnaire to 700 members of the American Otological o·tol·o·gy n. The branch of medicine that deals with the structure, function, and pathology of the ear. o Society and the American Neurotology Society. These physicians were asked about the frequency, results, and complications of surgical procedures for Meniere 's disease that they had performed between Jan. 1, 1990, and Dec. 31, 1999. Questionnaires were returned by 137 surgeons (19.6%). Their responses indicated that the number of vestibular ves·tib·u·lar adj. Of, relating to, or serving as a vestibule, especially of the ear. Vestibular Pertaining to the vestibule; regarding the vestibular nerve of the ear which is linked to the ability to hear sounds. neurectomies, labyrinthectomies, and endolymphatic sac endolymphatic sac n. The dilated blind extremity of the endolymphatic duct. surgeries all decreased during 1999. Meanwhile, the use of office-administered intratympanic gentamicin gentamicin /gen·ta·mi·cin/ (jen?tah-mi´sin) an aminoglycoside antibiotic complex isolated from bacteria of the genus Micromonospora, therapy increased rapidly throughout the entire 10-year period, and by 1999 it had become the most frequently used invasive treatment for Meniere's disease. Surgeons now seem to reserve inpatient procedures for cases where intratympanic gentamicin fails to control vertigo. Introduction The surgical treatment of Meniere's disease has evolved significantly during the past decade. In 1992, we published a survey of 58 head and neck surgeons regarding their use of vestibular neurectomy neurectomy /neu·rec·to·my/ (ndbobr-rek´tah-me) excision of a part of a nerve. neu·rec·to·my n. Surgical removal of a nerve or part of a nerve. , which at that time was gaining popularity as a surgical treatment for Meniere's disease. (1) Because more than 10 years had passed since the completion of our previous survey, we thought it appropriate to conduct another to ascertain any new trends in surgeons' treatment preferences and outcomes in the surgical management of Meniere s disease. Specifically, we attempted to determine the number of each type of procedure that had been performed, success rates, rates of hearing loss, complications, first- and second-line surgical treatment preferences, and respondents' opinions regarding changing trends. In this article, we elaborate on these findings and others. Methods and materials We mailed questionnaires to virtually every member of the American Otological Society and the American Neurotology Society (n = 700) to ascertain trends in surgical procedures used to treat Meniere's disease in United States citizens between Jan. 1, 1990, and Dec. 31, 1999. Response data were entered into a Microsoft Excel (tool) Microsoft Excel - A spreadsheet program from Microsoft, part of their Microsoft Office suite of productivity tools for Microsoft Windows and Macintosh. Excel is probably the most widely used spreadsheet in the world. Latest version: Excel 97, as of 1997-01-14. 2000 spreadsheet and statistically analyzed with the assistance of a personal computer. Results Of the 700 questionnaires mailed, we received 137 responses (19.6%). Results indicated that 79.6% of respondents were fellowship-trained, 81.0% had performed vestibular neurectomies, 89.8% had performed labyrinthectomies, 85.4% had performed endolymphatic sac surgery, and 72.3% had used intratympanic gentamicin therapy (table). A clear trend emerged over the 10-year period in that there was an exponential increase in the use of intratympanic gentamicin therapy; the number of such procedures rose from fewer than 100 in 1990 to more than 900 in 1999 (figure 1). There was also an overall increase in the number of endolymphatic sac surgeries performed over the entire 10-year span, although a sharp decline was seen in the final year of the study. The number of labyrinthectomies remained fairly constant throughout the decade, and the number of vestibular neurectomies slowly declined. By the end of the decade, intratympanic gentamicin therapy had risen from the least-used modality to the most frequently used. More than half (53.8%) of the 106 respondents who answered this particular question said they were treating more Meniere s disease patients with intratympanic gentamicin because it is minimally invasive and can be performed in the office. Vertigo-control rates varied among the four treatments. Cure rates of 90% or better were reported following 86.5% of the vestibular neurectomies, 90.2% of the labyrinthectomies, 6.0% of the endolymphatic sac surgeries, and 29.3% of the intratympanic gentamicin procedures (figure 2). While information regarding the incidence of complications associated with each procedure was solicited in the questionnaire, responses were sparse; this made it difficult to draw generalizations or conclusions. We did determine that endolymphatic sac surgery resulted in a lower incidence of postoperative hearing loss than did either vestibular neurectomy or intratympanic gentamicin (figure 3). As first-line surgical treatment, 48.9% of the 137 respondents chose endolymphatic sac procedures, while 33.6% opted for intratympanic gentamicin. For second-line treatment, vestibular neurectomy was preferred by 40.1% of respondents, followed by labyrinthectomy at 17.5%. Discussion For many years, the Years, The the seven decades of Eleanor Pargiter’s life. [Br. Lit.: Benét, 1109] See : Time mainstay of therapy for symptoms of classic unilateral Meniere s disease included various medical regimens such as low-salt diets, diuretics Diuretics Definition Diuretics are medicines that help reduce the amount of water in the body. Purpose Diuretics are used to treat the buildup of excess fluid in the body that occurs with some medical conditions such as congestive heart , carbonic anhydrase inhibitors Carbonic anhydrase inhibitors are a class of pharmaceuticals that suppress the activity of carbonic anhydrase. Types Acetazolamide is an inhibitor of carbonic anhydrase. It is used for glaucoma, epilepsy (rarely), benign intracranial hypertension, and altitude sickness. , betahistine and other vasodilators Vasodilators Definition Vasodilators are medicines that act directly on muscles in blood vessel walls to make blood vessels widen (dilate). Purpose Vasodilators are used to treat high blood pressure (hypertension). , calcium channel blockers Calcium Channel Blockers Definition Calcium channel blockers are medicines that slow the movement of calcium into the cells of the heart and blood vessels. , and vitamin supplements. Vertigo-control rates of 87% and higher have been reported with these conservative measures. The management of patients who do not respond to such conservative therapy has been controversial. For patients who already have a significant hearing loss, labyrinthectomy is a viable and straightforward option. But for patients who still maintain functional hearing, vestibular nerve vestibular nerve n. The superior part of the vestibulocochlear nerve peripheral to the vestibulocochlear nerve root, composed of nerve processes that have their terminals on hair cells of the ampullae of the semicircular ducts and the maculas of the section, endolymphatic sac surgery, and intratympanic aminoglycoside aminoglycoside /ami·no·gly·co·side/ (-gli´ko-sid) any of a group of antibacterial antibiotics (e.g., streptomycin, gentamicin) derived from various species of Streptomyces therapy should be considered. In our 1992 survey, we found that the popularity of vestibular neurectomy had grown significantly during the preceding decade. (1) In fact, by the end of the study decade, it had become the most favored procedure, and surgeons were achieving excellent vertigo-control rates in patients with serviceable hearing. A decade later, a gradual decline in the number of neurectomies is evident, and surgeons have shifted their treatment strategies toward more conservative initial surgical approaches-that is, endolymphatic sac surgery, which is associated with a low incidence of morbidity, and intratympanic gentamicin, which was new and not widely used in the United States at the time of ourprevious report. Today, vestibular neurectomy and labyrinthectomy appear to be reserved for patients who have not responded to the more conservative methods and for those without hearing. Certainly, many limitations are inherent in the survey method of data collection in general and in our survey in particular. It is possible that some respondents did not review their results in detail before answering the questionnaire. Responses often appeared to reflect impressions rather than precisely calculated figures. Moreover, data were not gathered by each respondent in a controlled orprospective fashion. Finally, approximately 80% of the members of the American Otological Society and the American Neurotology Society did not respond. We are unable to draw any conclusions regarding the nationwide treatment of Meniere s disease, given such a large number of unrepresented unrepresented adj → nicht vertreten surgeons. Nevertheless, we believe that the responses we did receive provide a great deal of valid information about changing trends in surgical techniques and thought processes This is a list of thinking styles, methods of thinking (thinking skills), and types of thought. See also the List of thinking-related topic lists, the List of philosophies and the . . Endolymphatic sac surgery. Numerous reports on endolymphatic sac surgery have appeared in the literature, and several procedures have been proposed to control or eliminate the symptoms of Meniere' s disease. (2,3) These procedures include the use of the endolymphatic endolymphatic pertaining to or emanating from the endolymph. endolymphatic duct connects the saccule of the membranous labyrinth of the internal ear to the endolymphatic sac. sac-mastoid shunt To divert, switch or bypass. , the endolymphatic sac-subarachnoid shunt, and wide endolymphatic sac decompression endolymphatic sac decompression ENT A reduction of endolymph volume by ↑ drainage or ↑ absorption without damaging the vestibular labyrinth; control of vertigo is seen in 65% of Pts, which diminishes to ≤ 50% in a 10 yr follow-up; hearing stabilization . Endolymphatic sac-mastoid shunt surgery was first described by G. Portmann in 1927. (4) In a 1969 report of a large series of patients who had undergone this procedure, M. Portmann found that vertigo was alleviated in 93% of patients. (5) Since then, variations on G. Portmann's original procedure have been described by Morrison, (6) Paparella and Goycoolea, (7) Goldenberg and Justus, (8) Gibson, (9) Huang and Lin, (10) and Arenberg, (11) and their vertigo-control rates ranged from 74 to 90%. Perhaps the most controversial study of endolymphatic sac surgery was published in 1989 by Bretlau et al, who compared it with simple mastoidectomy Mastoidectomy Definition Mastoidectomy is a surgical procedure to remove an infected portion of the bone behind the ear when medical treatment is not effective. This surgery is rarely needed today because of the widespread use of antibiotics. . (12) One might think that their finding that good vertigo control was achieved in approximately 70% of patients in both groups would have quelled much of the enthusiasm that had been generated for endolymphatic sac surgery. But such was apparently not the case, as our survey found that use of this procedure increased throughout most of the 1990s. This finding suggests that our respondents harbored doubts about the findings of Bretlau et al. Because sac surgery poses a limited risk to cochlear cochlear pertaining to or emanating from the cochlea. cochlear duct the coiled portion of the membranous labyrinth located inside the cochlea; contains endolymph. cochlear nerve see Table 14. function, many surgeons continue to use it as a mainstay of the surgical management of Meniere's disease symptoms in order to preserve hearing. Vestibular neurectomy. Vestibular nerve section is the most successful method of curing vertigo while preserving hearing in patients with Meniere's disease. (13) Early vestibular neurectomies via the suboccipital approach were performed in the 1920s and 1930s by Dandy (14) and McKenzie. (15) However, the procedure then went virtually unused from 1945 until 1961, when House introduced the middle fossa fossa /fos·sa/ (fos´ah) pl. fos´sae [L.] a trench or channel; in anatomy, a hollow or depressed area. acetabular fossa a nonarticular area in the floor of the acetabulum. approach. (16) In subsequent years, the use of the middle fossa approach was not uncommon, but it never achieved widespread popularity, largely because of its technical difficulty, limited applicability in older patients, and high incidence of complications, including hearing loss and facial weakness Facial weakness is a medical sign associated with a variety of medical conditions. Some specific conditions associated with facial weakness include:
In 1972, Hitselberger and Pulec described the retrolabyrinthine approach for trigeminal nerve trigeminal nerve n. The chief sensory nerve of the face and the motor nerve of the muscles of chewing. The nuclei of the nerve are in the mesencephalon and in the pons and extend down into the cervical portion of the spinal cord. sections. (17) Later, Silverstein and Norrell reintroduced vestibular neurectomy via the posterior fossa Posterior fossa may refer to:
Intratympanic gentamicin. The popularity of the minimally invasive intratympanic aminoglycoside procedure increased dramatically during the 1990s. Developed in Europe by Beck and Schmidt (19) and Odkvist, (20) this treatment has become more common in North America North America, third largest continent (1990 est. pop. 365,000,000), c.9,400,000 sq mi (24,346,000 sq km), the northern of the two continents of the Western Hemisphere. largely as a result of the work of Nedzelski et al. (21) According to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. our latest survey, the number of gentamicin procedures increased more than 13-fold during the 1990s, and it is now the most widely used treatment modality treatment modality Medtalk The method used to treat a Pt for a particular condition . The fact that antibiotics cause ototoxicity Ototoxicity Definition Ototoxicity is damage to the hearing or balance functions of the ear by drugs or chemicals. Description Ototoxicity is drug or chemical damage to the inner ear. became evident decades ago when streptomycin streptomycin (strĕp'tōmī`sĭn), antibiotic produced by soil bacteria of the genus Streptomyces and active against both gram-positive and gram-negative bacteria (see Gram's stain), including species resistant to other was first used for the treatment of tuberculosis. (22) In 1948, Fowler published one of the earliest reports of the intentional application of streptomycin toxicity. (23) We must credit Schuknecht, however, with developing a method of delivering topical antibiotics Antibiotics, Topical Definition Topical antibiotics are medicines applied to the skin to kill bacteria. Purpose Topical antibiotics help prevent infections caused by bacteria that get into minor cuts, scrapes, and burns. to patients with unilateral Meniere' s disease. In 1957, he published his report on the use of a middle ear catheter to perfuse per·fuse v. 1. To pour or diffuse a liquid over or through something. 2. To force blood or other fluid to flow from the artery through the vascular bed of a tissue or to flow through the lumen of a hollow structure. streptomycin into eight vertigo patients. (24) Vertigo control was achieved in all eight, but five of them experienced a complete unilateral hearing loss Unilateral hearing loss (UHL) or single-sided deafness (SSD) is a type of hearing impairment where there is normal hearing in one ear and impaired hearing in the other ear. . Since the publication of these pioneering studies, many other authors have reported excellent vertigo-control rates with intratympanic streptomycin, albeit at the expense of substantial associated hearing loss. Although it is still unclear which drug has the best profile with regard to maximum vestibulotoxicity and minimum cochleotoxicity in patients with Meniere's disease, most cli nicians use gentamicin. Various protocols are used to deliver gentamicin to the inner ear, including direct transtympanic instillation instillation /in·stil·la·tion/ (in?sti-la´shun) administration of a liquid drop by drop. instillation administration of a liquid drop by drop. , blind injection, round window membrane microcatheterization, and injection via the Silverstein MicroWick. (25-28) The standard gentamicin solution is a 40-mg/ml concentration. To minimize patient discomfort, most practitioners buffer the solution with sodium bicarbonate sodium bicarbonate or sodium hydrogen carbonate, chemical compound, NaHCO3, a white crystalline or granular powder, commonly known as bicarbonate of soda or baking soda. It is soluble in water and very slightly soluble in alcohol. to achieve a final gentamicin concentration of 26.7 mg/ml. To determine when to discontinue therapy, many physicians use symptom control as the endpoint. Others titrate ti·trate v. To determine the concentration of a solution by titration or perform the operation of titration. ti the doses to maintain good hearing or to achieve a desired reduction in vestibular response as measured by electronystagmography. These methods have been met with varying degrees of success, but hearing loss is still a concern. Some surgeons have contemplated the benefits of low-dose continuous-infusion therapy in an effort to maximize vestibular ablation while minimizing damage to the cochlear reserve. DeCicco et al reported excellent results with microdoses of dilute gentamicin (10 mg/ml) delivered though a microcatheter implanted in the round window niche. (27) They reported no changes in hearing or reduction in vestibular response. Their findings suggest that gentamicin must relieve the vertigo of Meniere's disease by some mechanism other than the destruction of vestibular function. One possible explanation is that the gentamicin affects the dark cells of the vestibular labyrinth vestibular labyrinth n. The portion of the membranous labyrinth located within the semicircular canals and the vestibule of the osseous labyrinth. and the secretory secretory /se·cre·to·ry/ (se-kre´tah-re) (se´kre-tor?e) pertaining to secretion or affecting the secretions. se·cre·to·ry adj. Relating to or performing secretion. cells in the stria vascularis, which reduces the secretion of endolymph endolymph /en·do·lymph/ (en´do-limf) the fluid within the membranous labyrinth.endolymphat´ic en·do·lymph n. The fluid contained in the membranous labyrinth of the inner ear. , thereby reducing endolymphatic hydrops endolymphatic hydrops n. See Meniere's disease. endolymphatic hydrops Ménière's disease, see there . In 1998, Silverstein developed the MicroWick with these considerations in mind. (28) The cylindrical MicroWick is made of polyvinylacetate and measures 1 mm in diameter and 9 mm in length. It is placed through a silicone ventilation tube (inner ear diameter: 1.42 mm) that is equipped with a 3.25-mm diameter flexible flange flange (flanj) a projecting border or edge; in dentistry, that part of the denture base which extends from around the embedded teeth to the border of the denture. flange n. 1. (Micromedics; Eagan, Minn.). The patient places a dilute concentration of gentamicin (10mg/ml) into an eardropper and instills it three times per day. The MicroWick gives patients the convenience and flexibility to treat themselves at home, and it has the advantage of allowing for sustained low-dose infusion. The therapeutic endpoint therapeutic endpoint, n the defining factors that denote the end of a therapeutic process, such as the return to gingival health, reduction of pocket depth, and a stable clinical attachment level. is determined when the physician notes the appropriate balance between the amount of vestibular ablation (as measured by electronystagmography) and the progression of hearing loss. In conclusion, our data provide evidence that surgeons are becoming increasingly comfortable with intratympanic gentamicin. Its ease of administration means that its popularity should continue to increase as both a first- and second-line treatment. [FIGURE 1 OMITTED]
Table
Survey results
I. Miscellaneous data
Number of questionnaires mailed: 700
Usable returns: 137 (19.6%)
Respondents' mean age: 51 years
Respondents' mean length of practice: 19 years
Number of respondents who received fellowship
training: 109 (79.6%)
Number of respondents who based their answers on...
estimates: 118 (86.1%)
actual data: 18 (13.1%)
both: 1 (0.7%)
II. Vestibular neurectamy
Number of the 137 respondents who...
performed vestibular neurectomies: 111 (81.0%)
did not perform vestibular neurectomies: 26 (19.0%)
Total number of vestibular neurectomies performed
during each survey year...
1990: 337
1991: 374
1992: 402
1993: 396
1994: 367
1995: 377
1996: 353
1997: 360
1998: 333
1999: 246
Ten-year total for all respondents: 3,545
Number of the 111 respondents who performed
vestibular neurectomies who used...
only the posterior fossa approach: 78 (70.3%)
only the middle fossa approach: 9 (8.1%)
both approaches: 24 (21.6%)
Number of the 111 respondents whose vertigo cure
rates were between...
90 and 100%: 96 (86.5%)
80 and 89%: 13 (11.7%)
70 and 79%: 1 (0.9%)
<70%: 0
no answer: 1 (0.9%)
Number of the 111 respondents according to the
percentage of their patients who experienced hearing
loss (either a 10-dB hearing loss or a 15% decrease in
speech discrimination score) following surgery...
0 to 10% of patients: 76 (68.5%)
11 to 20% of patients: 21 (18.9%)
21 to 30% of patients: 10 (9.0%)
31 to 40% of patients: 1 (0.9%)
>40% of patients: 2 (1.8%)
no answer: 1 (0.9%)
Number of 109 respondents who answered who
felt that the number of neurectomies was...
decreasing: 77 (70.6%)
increasing: 4 (3.7%)
remaining constant: 28 (25.7%)
III. Labyrinthectomy
Number of the 137 respondents who ...
performed labyrinthectomies: 123 (89.8%)
did not perform labyrinthectomies: 12 (8.8%)
no answer: 2 (1.5%)
Total number of labyrinthectomies performed
during each survey year...
1990: 182
1991: 196
1992: 187
1993: 204
1994: 239
1995: 223
1996: 233
1997: 249
1998: 267
1999: 217
Ten-year total for all respondents: 2,197
Number of the 123 respondents who performed
labyrinthectomies who used...
only the transmastoid approach: 86 (69.9%)
only the transcanal approach: 10 (8.1%)
both approaches: 27 (22.0%)
Number of the 123 respondents whose vertigo
cure rates were between...
90 and 100%: 111 (90.2%)
80 and 89%: 7 (5.7%)
70 and 79%: 1 (0.8%)
<70%: 0
no answer: 4 (3.3%)
Number of 124 respondents who answered who
felt that the number of labyrinthectomies was...
decreasing: 67 (54.0%)
increasing: 5 (4.0%)
remaining constant: 52 (41.9%)
IV. Endolymphatic sac surgery
Number of the 137 respondents who...
performed endolymphatic sac surgery: 117 (85.4%)
did not perform endolymphatic sac surgery: 20 (14.6%)
Total number of endolymphatic sac surgeries performed
during each survey year...
1990: 553
1991: 641
1992: 592
1993: 658
1994: 723
1995: 773
1996: 835
1997: 843
1998: 874
1999: 736
Ten-year total for all respondents: 7,228
Number of the 117 respondents who perform
endolymphatic sac surgery whose vertigo cure
rates were between ...
90 and 100%: 7 (6.0%)
80 and 89%: 21 (17.9%)
70 and 79%: 67 (57.3%)
<70%: 12 (10.3%)
no answer: 10 (8.5%)
Number of the 117 respondents according to the
percentage of their patients who experienced hearing
loss (either a 10-dB hearing loss or a 15% decrease in
speech discrimination score) following surgery ...
0 to 10% of patients: 91 (77.8%)
11 to 20% of patients: 7 (6.0%)
21 to 30% of patients: 0
31 to 40% of patients: 1 (0.9%)
>40% of patients: 0
no answer: 18 (15.4%)
Number of 112 respondents who answered who felt
that the number of endolymphatic sac surgeries was ...
decreasing: 50 (44.6%)
increasing: 16 (14.3%)
remaining constant: 46 (41.1%)
V. Intratympanic gentamicin
Number of the 137 respondents who ...
used intratympanic gentamicin: 99 (72.3%)
did not use intratympanic gentamicin: 36 (26.3%)
no answer: 2 (1.5%)
Total number of intratympanic gentamicin procedures
performed during each survey year...
1990: 68
1991: 73
1992: 161
1993: 217
1994: 306
1995: 362
1996: 475
1997: 656
1998: 856
1999: 917
Ten-year total for all respondents: 4,091
Number of the 99 respondents who use intratympanic
gentamicin who ...
used transtympanic injection: 96 (97.0%)
placed Gelfoam in the round window: 12 (12.1%)
removed adhesions from the round window: 16 (16.2%)
Number of the 99 respondents who used intratympanic
gentamicin whose vertigo cure rates were between ...
90 and 100%: 29 (29.3%)
80 and 89%: 40 (40.4%)
70 and 79%: 22 (22.2%)
<70%: 0
no answer: 8 (8.1 %)
Number of the 99 respondents according to the percentage
of their patients who experienced hearing loss (either
a 10-dB hearing loss or a 15% decrease in speech
discrimination score) following intratympanic gentamicin ...
0 to 10% of patients: 47 (47.5%)
11 to 20% of patients: 25 (25.3%)
21 to 30% of patients: 7 (7.1%)
31 to 40% of patients: 2 (2.0%)
>40% of patients: 10 (10.1 %)
no answer: 8 (8.1%)
Number of 104 respondents who answered who felt
that the use of intratympanic gentamicin was ...
decreasing: 16 (15.4%)
increasing: 73 (70.2%)
remaining constant: 15 (14.4%)
Number of 106 respondents who answered who were ...
treating more patients with Meniere's disease with
intratympanic gentamicin because it is less invasive
and can be administered in the office: 57 (53.8%)
not treating more patients with Meniere's disease with
intratympanic gentamicin because it is less invasive
and can be administered in the office: 49 (46.2%)
Treatment preferences
Number of the 137 respondents whose first-line
treatment choice was ...
endolymphatic sac surgery: 67 (48.9%)
intratympanic gentamicin: 46 (33.6%)
vestibular neurectomy: 8 (5.8%)
labyrinthectomy: 0
no answer: 16 (11.7%)
Number of the 137 respondents whose second-line
treatment choice was ...
vestibular neurectomy: 55 (40.1%)
labyrinthectomy: 24 (17.5%)
intratympanic gentamicin: 20 (14.6%)
endolymphatic sac surgery: 11 (8.0%)
no answer: 27 (19.7%)
Figure 2.
Percentages of respondents who reported various ranges of
vertigo-control rates for each procedure (VN = vestibular neurectomy; L
= labyrinthectomy; ES = endolymphatic sac surgery; IG = labyrinthectomy;
ES = endolymphatic sac surgery; IG = intratympanic gentamicin).
Percentage of respondents
Cure rates VN L ES IG
90 to 100% 86.5 90.2 6.0 29.3
80 to 89% 11.7 5.7 17.9 40.4
70 TO 79% 0.9 0.8 57.3 22.2
<70% 0 0 10.3 0
Note: Table made from bar graph
Figure 3.
Percentages of respondents who reported various ranges of patients who
experienced hearing loss following each procedure (VN = vestibular
neurectomy; ES = endolymphatic sac surgery; IG = intratympanic
gentamicin).
Percentage of respondents
Percentage of patients
who experiened hearing loss VN ES IG
0 to 10% 68.5 77.8 47.5
11 to 20% 18.9 6.0 25.3
21 to 30% 9.0 0 7.1
31 to 40% 0.9 0.9 2.0
>40% 1.8 0 10.1
Note: Table made from bar graph
References (1.) Silverstein H, Wanamaker H, Flanzer J, Rosenberg S. Vestibular neurectomy in the United States--1990. Am J Otol 1992;13:23-30. (2.) Shah DK, Kartush JM. Endolymphatic sac surgery in Meniere's disease. Otolaryngol Clin North Am 1997;30:1061-74. (3.) Brown JS. A ten year statistical follow-up of 245 consecutive cases of endolymphatic shunt decompression and 328 consecutive cases of labyrinthectomy. Laryngoscope la·ryn·go·scope n. A tubular endoscope that is inserted through the mouth and into the larynx and that is used for examining the interior of the larynx. la·ryn 1983;93 (11 Pt 1):1419-24. (4.) Portmann G. The saccus endolymphaticus and an operation for draining the same for the relief of vertigo. 1927. J Laryngol Otol 1991;105:1109-12. (5.) Portmann M. Endolymphatic sac surgery. Arch Otolaryngol 1969;89:101-3. (6.) Morrison AW. The surgery of vertigo: Saccus drainage for idiopathic endolymphatic hydrops. J Laryngol Otol 1976;90:87-93. (7.) Paparella MM, Goycoolea M. Panel of Meniere's disease. Endolymphatic sac enhancement surgery for Meniere's disease: An extension of conservative therapy. Ann Otol Rhinol Laryngol 198l;90:610-5. (8.) Goldenberg RA, Justus MA. Endolymphatic mastoid mastoid /mas·toid/ (mas´toid) 1. breast-shaped. 2. mastoid process. 3. pertaining to the mastoid process. mas·toid n. The mastoid process. shunt for treatment of Meniere's disease: A five year study. Laryngoscope 1983;93:1425-9. (9.) Gibson WP. A study of endolymphatic sac surgery. The results after reconstructing the sac versus those in operations that failed to open the lumen and satisfactorily insert a silastic Silastic /Si·las·tic/ (si-las´tik) trademark for polymeric silicone substances that have the properties of rubber but are biologically inert; used in surgical prostheses. implant. Otolaryngol Clin North Am 1983;16:181-8. (10.) Huang TS, Lin CC. Endolymphatic sac surgery for Meniere's disease: A composite study of 339 cases. Laryngoscope 1985;95:1082-6. (11.) Arenberg IK. Results of endolymphatic sac to mastoid shunt surgery for Meniere's disease refractory to medical therapy. Am J Otol 1987;8:335-44. (12.) Bretlau P. Thomsen J, Tos M, Johnsen NJ. Placebo effect placebo effect n. A beneficial effect in a patient following a particular treatment that arises from the patient's expectations concerning the treatment rather than from the treatment itself. in surgery for Meniere's disease: Nine-year follow-up. Am J Otol 1989;10:259-61. (13.) Silverstein H, Norrell H. Retrolabyrinthine vestibular neurectomy. Otolaryngol Head Neck Surg 1982;90:778-82. (14.) Dandy WE. Meniere's disease: Its diagnosis and a method of treatment. Arch Surg 1928;16:1127-52. (15.) McKenzie KG. Intracranial intracranial /in·tra·cra·ni·al/ (-kra´ne-al) within the cranium. in·tra·cra·ni·al adj. Within the cranium. division of the vestibular portion of the auditory nerve auditory nerve n. See cochlear nerve. for Meniere's disease. Can Med Assoc J 1936;34:369-81. (16.) House WF. Surgical exposure of the internal auditory canal auditory canal n. Either of two passages of the ear, the internal or the external acoustic meatus. See under acoustic meatus. and its contents through the middle cranial fossa The middle fossa, deeper than the anterior cranial fossa, is narrow in the middle, and wide at the sides of the skull. It is bounded in front by the posterior margins of the small wings of the sphenoid, the anterior clinoid processes, and the ridge forming the anterior . Laryngoscope 1961;71:1363-85. (17.) Hitselberger WE, Pulec JL. Trigeminal nerve (posterior root posterior root n. See dorsal root. ) retrolabyrinthine selective section. Operative procedure for intractable pain intractable pain Refractory pain Pain medicine Persistent pain which does not respond to at least 3 dosease of parenteral analgesics given over a 12-24 hr period; pain that does not respond to appropriate doses of opioid analgesics. . Arch Otolaryngol 1972;96:412-5. (18.) Silverstein H, Norrell H. Retrolabyrinthine surgery: A direct approach to the cerebellopontine angle. Otolaryngol Head Neck Surg 1980;88:462-9. (19.) Beck C, Schmidt CL. 10 years of experience with intratympanically applied streptomycin (gentamycin) in the therapy of Morbus Meniere. Arch Otorhinolaryngol 1978;221:149-52. (20.) Odkvist LM. Middle ear ototoxic ototoxic /oto·tox·ic/ (o´to-tok?sik) having a deleterious effect upon the eighth nerve or on the organs of hearing and balance. o·to·tox·ic adj. treatment for inner ear disease. Acts Otolaryngol 1988;457(Suppl):83-6. (21.) Nedzelski JM, Chiong CM, Fradet G, et al. Intratympanic gentamicin instillation as treatment of unilateral Meniere's disease: Update of an ongoing study. Am J Otol 1993;14:278-82. (22.) Hirsch BE, Kamerer DB. Role of chemical labyrinthectomy in the treatment of Meniere's disease. Otolaryngol Clin North Am 1997;30:1039-49. (23.) Fowler EP. Streptomycin treatment of vertigo. Trans Am Acad Ophthalmol Otolaryngol 1948;52:239-301. (24.) Schuknecht HF. Ablation therapy ablation therapy See Ablation–cardiology. in the management of Meniere's disease. Acta Otolaryngol 1957;132(Suppl):1-42. (25.) Youssef TF, Poe DS. Intratympanic gentamicin injection for the treatment of Meniere's disease. Am J Otol 1998;19:435-42. (26.) Silverstein H, Arruda J, Rosenberg SI, et al. Direct round window membrane application of gentamicin in the treatment of Meniere' s disease. Otolaryngol Head Neck Surg 1999;120:649-55. (27.) DeCicco MJ, Hoffer ME, Kopke RD, et al. Round-window microcatheter-administered microdose gentamicin: Results from treatment of tinnitus Tinnitus Definition Tinnitus is hearing ringing, buzzing, or other sounds without an external cause. Patients may experience tinnitus in one or both ears or in the head. associated with Meniere's disease. Int Tinnitus J 1998;4:141-3. (28.) Silverstein H, Jackson LE, Rosenberg SI. Silverstein MicroWick for the treatment of inner ear disease. Operative Techniques in Otolaryngology-Head and Neck Surgery 2001;12:144-7. From the Ear Research Foundation, Sarasota, Fla. Reprint requests: Herbert Silverstein, MD, Florida Ear and Sinus Center, 1961 Floyd St., Suite A, Sarasota, FL 34239. Phone: (941) 366-9222; tax: (941) 365-2269; e-mail: hsilverstein@aol.com This study was supported by a grant from the Ear Research Foundation of Sarasota, Fla., and was originally presented at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery; Sept. 27, 2000; Washington, D.C. |
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