Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Otol Neurotol. 2021 Jan;42(1):116-120. doi: 10.1097/MAO.0000000000002841.
Menière's disease can be a debilitating condition but in most cases the symptoms are controlled by lifestyle changes and medical management. However, some patients remain symptomatic despite medical treatment and have the option of more invasive surgical treatments. Surgical intervention for Menière's includes a range of interventions from grommet insertion, intratympanic steroids/Gentamicin, endolymphatic sac decompression, labyrinthectomy, and vestibular neurectomy. A recently described technique involves the occlusion of all three semi-circular canals as an alternative in intractable Menière's disease.
This is a case series of three patients who underwent triple canal occlusion for the treatment of intractable Menière's disease.
Patients were selected from those who were referred to Queen Elizabeth Hospital in Birmingham, a tertiary referral center.
Patients who were severely symptomatic despite medical treatment who were considering ablative therapy were offered the option of triple canal occlusion as an alternative.
We report a series of Menière's patients treated by triple canal occlusion, describe the rationale behind this intervention, the surgical technique, and preliminary results.
Each patient was followed up for a minimum of 2 years following the procedure. The main outcomes measures were the class of vertigo control and hearing threshold levels according to the American Academy of Otolaryngology-Head and Neck Surgery guidelines.
Of the three patients, two were men and one was woman, the age range was 45 years to 61 years old. Two patients with unilateral disease achieved class A control whereas one patient with bilateral disease achieved class B control. Two patients who underwent the procedure had little or no effect to their hearing on the treated side however one patient suffered a 30 dB hearing loss on the operative side.
Based on our limited experience and the early reports in the literature we consider that there are potential patient benefits for triple canal occlusion for intractable Menière's disease as an alternative to vestibular neurectomy due to the reduced morbidity and long-term efficacy.
梅尼埃病可能是一种使人虚弱的疾病，但在大多数情况下，通过生活方式改变和医学管理可以控制症状。然而，一些患者尽管接受了治疗仍有症状，并有选择更具侵袭性的手术治疗。梅尼埃病的手术干预包括一系列干预措施，从鼓膜置管、鼓室内类固醇/庆大霉素、内淋巴囊减压、迷路切除术和前庭神经切除术。最近描述的一种技术是将所有三个半规管闭塞作为难治性梅尼埃病的替代方法。
这是一组三例患者的病例系列，他们因难治性梅尼埃病接受了三管闭塞治疗。
从转诊到伯明翰伊丽莎白女王医院的患者中选择患者，这是一家三级转诊中心。
尽管经过药物治疗仍有严重症状并考虑消融治疗的患者，可选择三管闭塞作为替代方法。
我们报告了一系列接受三管闭塞治疗的梅尼埃病患者，描述了这种干预措施的基本原理、手术技术和初步结果。
每位患者在手术后至少随访 2 年。主要观察指标是根据美国耳鼻喉科学-头颈外科学会指南评估的眩晕控制等级和听力阈值水平。
在这 3 例患者中，2 例为男性，1 例为女性，年龄范围为 45 岁至 61 岁。2 例单侧疾病患者达到 A 级控制，1 例双侧疾病患者达到 B 级控制。2 例接受手术的患者在治疗侧几乎没有或没有听力影响，但有 1 例患者在手术侧听力损失 30dB。
根据我们有限的经验和文献中的早期报告，我们认为对于难治性梅尼埃病，三管闭塞作为前庭神经切除术的替代方法具有潜在的患者获益，因为其具有较低的发病率和长期疗效。
