顽固性梅尼埃病的内淋巴囊手术 10 年回顾。

10-year review of endolymphatic sac surgery for intractable meniere disease.

机构信息

Department of Otolaryngology, University of Western Ontario, London, Ontario.

出版信息

J Otolaryngol Head Neck Surg. 2010 Aug;39(4):415-21.

PMID:20643008

Abstract

OBJECTIVE

To review our 10-year experience of endolymphatic sac surgery (ESS) for intractable Meniere disease (MD).

DESIGN

Retrospective chart review and survey.

SETTING

Tertiary care centre.

METHODS

Patients presenting for ESS from 1998 to 2007 were reviewed using the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. A quality of life (QOL) questionnaire was mailed out using the Dillman method.

MAIN OUTCOME MEASURES

(1) 1995 AAO-HNS hearing stage, vertigo class, and functional level; (2) complications and secondary treatments; (3) a 40-question, disease-specific, validated QOL questionnaire (Meniere's Disease Outcome Questionnaire).

RESULTS

Thirty patients (33 ears) had ESS (63.6% male, mean age 49 years, mean follow-up 30.6 months). Vertigo control was 35.5% class A, 29.0% class B, 6.5% class C, 0% class D, 3.2% class E, and 25.8% class F. If class A and B are considered successful, then 64.5% were successful. Hearing stage improved in 14.8%, remained the same in 51.9%, and worsened in 33.3%. Average preoperative functional level was 4.3 and postoperative level was 3.5 (p = .0016). Secondary treatment after ESS was performed in 26%. Three patients (10.0%) had profound sensorineural hearing loss. Twenty-five questionnaire responses (75.8%) were received. There was a significant increase in QOL scores (p = .000001), and 80% had an improvement in QOL scores.

CONCLUSIONS

ESS is a surgical option for MD that offers relief from vertigo in selected patients, but patients need to be cautioned about the risk of hearing loss and the requirement for subsequent destructive treatment in a significant proportion of cases.

摘要

目的

回顾我们 10 年来治疗难治性梅尼埃病（MD）的内淋巴囊手术（ESS）经验。

设计

回顾性图表审查和调查。

地点

三级保健中心。

方法

根据 1995 年美国耳鼻咽喉头颈外科学会（AAO-HNS）指南，对 1998 年至 2007 年间接受 ESS 的患者进行了回顾。使用 Dillman 方法邮寄了一份生活质量（QOL）问卷。

主要观察指标

（1）1995 年 AAO-HNS 听力阶段、眩晕分级和功能水平；（2）并发症和二次治疗；（3）使用疾病特异性、经过验证的 QOL 问卷（梅尼埃病结局问卷）进行的 40 个问题的调查。

结果

30 例（33 耳）患者接受 ESS（63.6%为男性，平均年龄 49 岁，平均随访 30.6 个月）。眩晕控制为 A 级 35.5%、B 级 29.0%、C 级 6.5%、D 级 0%、E 级 3.2%和 F 级 25.8%。如果将 A 级和 B 级视为成功，那么成功率为 64.5%。听力分级改善 14.8%，不变 51.9%，恶化 33.3%。术前功能分级平均为 4.3，术后为 3.5（p =.0016）。ESS 后行二次治疗 26%。3 例（10.0%）患者出现严重感音神经性听力损失。收到 25 份问卷回复（75.8%）。QOL 评分显著提高（p =.000001），80%的患者 QOL 评分得到改善。