Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45267-0528, USA.
Laryngoscope. 2010 Mar;120(3):591-7. doi: 10.1002/lary.20787.
OBJECTIVES/HYPOTHESIS: Comparison of audiometric outcomes between patients with definite Meniere's disease who underwent endolymphatic mastoid sac surgery (EMSS) following failed medical therapy and patients who underwent medical therapy only.
Retrospective chart review of 456 consecutive patients between 1997 and 2006.
Outcome measures were changes in pure-tone average (PTA), word recognition score (WRS), and speech reception threshold (SRT).
Of 58 qualified patients, 29 who underwent EMSS after failing medical therapy showed a 4 dB decrease in PTA, a 2% increase in WRS, and a 2 dB decrease in SRT. Twenty-nine patients treated with medical therapy only demonstrated a 1 dB PTA increase, 2% WRS improvement, and 2 dB SRT improvement. No significant difference was noted between the medically and surgically managed patients in terms of changes in PTA (P = .34) or WRS (P = .95) after treatment. Of all patients in the study, 60% had no clinically significant change in hearing, whereas 24% improved and 16% worsened. The distribution of post-treatment hearing changes between the medical and surgical groups was statistically insignificant (P = .17).
The changes in PTA and WRS among patients with Meniere's disease managed with medical therapy or EMSS were not statistically significant. Although performing EMSS to treat the vertigo of Meniere's disease does not appear to be associated with an increased risk of deteriorating auditory function after treatment, surgery also does not confer an increased likelihood of stabilizing or improving hearing.
目的/假设：比较经药物治疗失败后行内淋巴囊乳突手术（EMSS）和仅行药物治疗的明确梅尼埃病患者的听力结果。
回顾性分析 1997 年至 2006 年间的 456 例连续患者的图表。
结局测量指标为纯音平均听阈（PTA）、言语识别率（WRS）和言语接受阈（SRT）的变化。
在 58 名合格患者中，29 名经药物治疗失败后行 EMSS 的患者 PTA 降低 4dB，WRS 增加 2%，SRT 降低 2dB。仅接受药物治疗的 29 名患者 PTA 增加 1dB，WRS 改善 2%，SRT 改善 2dB。在治疗后 PTA（P =.34）或 WRS（P =.95）的变化方面，药物和手术治疗的患者之间无显著差异。在研究中的所有患者中，60%的听力无明显变化，24%的听力改善，16%的听力恶化。在药物和手术组之间，治疗后听力变化的分布无统计学意义（P =.17）。
药物治疗或 EMSS 治疗的梅尼埃病患者的 PTA 和 WRS 变化无统计学意义。虽然进行 EMSS 治疗梅尼埃病的眩晕似乎不会增加治疗后听觉功能恶化的风险，但手术也不会增加听力稳定或改善的可能性。
