Department for Otorhinolaryngology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany.
German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany.
Eur Arch Otorhinolaryngol. 2023 Mar;280(3):1131-1145. doi: 10.1007/s00405-022-07582-6. Epub 2022 Aug 15.
Treatment of Menière's Disease (MD) comprises an array of both non-destructive and destructive treatment options. In patients who are therapy-refractory to non-destructive medical treatment, endolymphatic mastoid shunt surgery (EMSS) is both recommended and debated controversially. The aim of this study was to investigate safety in terms of hearing, vestibular function, complication rate, and efficacy with regards to vertigo control of EMSS in patients with MD according to the current diagnostic criteria of 2015.
Retrospective analysis of 47 consecutive patients with definite or probable MD with description of demographic parameters, pre- and postoperative MD treatment, pre- and postoperative audiometric (pure tone audiometry) and vestibular (caloric testing) results. The parameters were compared between patients with and without postoperative vertigo control.
31/47 patients (66.0%) had improved vertigo control postoperatively. Postoperative hearing and vestibular preservation were predominantly stable. No significant differences between patients with improved vertigo control and patients with no change or worse vertigo episodes were found. In the treatment refractory group, 4 patients required a revision EMSS and 6 a destructive MD treatment (5 gentamicin intratympanically, 1 labyrinthectomy). No peri- or postsurgical complications were reported.
EMSS was found to be beneficial in two thirds of the patients with definite or probable Morbus Menière and a safe procedure regarding hearing and vestibular preservation with no postoperative complications. Therefore, EMSS should be considered before inducing destructive treatment options, such as intratympanic gentamicin application or labyrinthectomy.
梅尼埃病（MD）的治疗包括一系列非破坏性和破坏性治疗选择。对于那些对非破坏性药物治疗无反应的患者，内淋巴乳突分流术（EMSS）既是推荐的，也是有争议的。本研究旨在根据 2015 年的诊断标准，调查 EMSS 在 MD 患者中的安全性，包括听力、前庭功能、并发症发生率和眩晕控制效果。
回顾性分析 47 例确诊或可能患有 MD 的连续患者的人口统计学参数、术前和术后 MD 治疗、术前和术后听力（纯音测听）和前庭（冷热测试）结果。比较术后眩晕控制患者和未控制患者的参数。
31/47 例患者（66.0%）术后眩晕控制得到改善。术后听力和前庭保护主要稳定。术后眩晕控制改善的患者与无变化或眩晕发作恶化的患者之间无显著差异。在治疗抵抗组中，4 例患者需要进行 EMSS 修正，6 例患者需要进行破坏性 MD 治疗（5 例鼓室内庆大霉素，1 例迷路切除术）。无围手术期或术后并发症。
EMSS 对明确或可能患有梅尼埃病的患者有三分之二的益处，并且在听力和前庭保护方面是安全的，没有术后并发症。因此，在进行破坏性治疗选择（如鼓室内庆大霉素应用或迷路切除术）之前，应考虑 EMSS。
