Service d'ORL et de Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire de Nantes (CHU), Hôtel-Dieu, 1, Place A. Ricordeau, BP 1005, 44093, Nantes Cedex 01, France.
Eur Arch Otorhinolaryngol. 2022 Mar;279(3):1193-1201. doi: 10.1007/s00405-021-06743-3. Epub 2021 Mar 19.
To evaluate objective vestibular function after endolymphatic sac surgery (ELSS) for Menière's disease (MD), using comparative vestibular function tests: videonystagmography (VNG), vestibular evoked myogenic potentials (VEMP) and video head-impulse test (VHIT) METHODS: Patients with definite MD using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) of 1995 criteria modified in 2015 and treated with ELSS (sac decompression or sac opening) were included. The primary outcome was the preservation of vestibular function, comparing pre- and postoperative vestibular function tests: VNG, VEMP, VHIT. Secondary outcomes were control of episodes of vertigo, hearing outcome using AAO-HNS criteria, and QoL using the Menière's disease outcome questionnaire.
73 patients were included in the study. We found a significant preservation of vestibular function as measured by VNG and VHIT. There was no statistical difference in the presence or absence of cervical and ocular (P13/N23 and N1/P1) waves on VEMP pre- and postoperatively. 67% of patients had good control of episodes of vertigo post-operatively, with significantly better results in the sac opening group (75%). There was no significant change in hearing postoperatively, and QoL scores were significantly improved after surgery (p < 0.0001).
Endolymphatic sac surgery (ELSS) is a conservative surgical treatment, which does not negatively impact vestibular function. It was associated with improved control of episodes of vertigo, preservation of hearing, and a clear improvement in QoL scores. Despite its pathophysiology not being fully understood, it remains a first-line procedure preserving vestibular function, for MD refractory to medical management.
通过比较前庭功能测试（视频眼震图（VNG）、前庭诱发肌源性电位（VEMP）和视频头脉冲试验（VHIT））评估内淋巴囊手术（ELSS）治疗梅尼埃病（MD）后的客观前庭功能。
纳入符合美国耳鼻喉科学-头颈外科学会（AAO-HNS）1995 年标准并于 2015 年修订、接受 ELSS（囊减压或囊切开）治疗的明确 MD 患者。主要结局是比较术前和术后前庭功能测试（VNG、VEMP、VHIT）评估的前庭功能保存情况。次要结局为眩晕发作控制情况、AAO-HNS 标准评估的听力结果以及 Menière's 疾病结局问卷（MDQ）评估的生活质量。
研究纳入 73 例患者。我们发现 VNG 和 VHIT 测量的前庭功能有显著保存。VEMP 术前和术后颈椎和眼（P13/N23 和 N1/P1）波的存在或缺失无统计学差异。术后 67%的患者眩晕发作得到良好控制，囊切开组的结果明显更好（75%）。术后听力无明显变化，生活质量评分明显提高（p < 0.0001）。
内淋巴囊手术（ELSS）是一种保守的手术治疗方法，不会对前庭功能产生负面影响。它与眩晕发作控制的改善、听力的保存以及生活质量评分的明显提高相关。尽管其病理生理学尚未完全了解，但对于药物治疗无效的 MD，它仍然是一种保留前庭功能的一线治疗方法。
