Department of Otolaryngology-Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011.
Clinical Medical Research Center for Otology in Hunan Province, Changsha 410011.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 May 28;49(5):712-720. doi: 10.11817/j.issn.1672-7347.2024.240376.
Ménière's disease (MD) is an idiopathic inner ear disorder characterized by recurrent episodes of episodic rotational vertigo, fluctuating hearing loss, tinnitus, and a feeling of ear stuffiness. Endolymphatic sac (ES)-related surgery is used primarily in patients with MD who have failed to respond to pharmacologic therapy. Endolymphatic duct blockage (EDB) is a new procedure for the treatment of MD, and related clinical studies are still scarce. This study aims to investigate the dynamic changes in endolymphatic hydrops (EH) and the long-term surgical outcomes in MD patients undergoing EDB, and to evaluate the impact of different types of ES on the surgical efficacy.
A retrospective analysis was conducted on 33 patients with refractory MD who underwent EDB. Based on the morphology of their endolymphatic sacs, patients were divided into a normal-type group (=14) and an atrophic-type group (=19). The frequency of vertigo symptoms, hearing, vestibular function, and the dynamic changes of gadolinium-enhanced MRI of the inner ear were compared were compared before and after surgery between the 2 groups.
Compared with the atrophic-type group, the patients in the normal-type group had a higher rate of complete vertigo control, better cochlear and vestibular function, and a lower endolymph to vestibule volume ratio (all <0.05). In addition, 7 patients in the normal-type group were found to have reversal of EH, while no reversal of EH was detected in the atrophic-type group after surgery.
The response to EDB treatment varies between normal and atrophic MD patients, suggesting that the 2 pathological types of endolymphatic sacs may have different underlying mechanisms of disease.
梅尼埃病（MD）是一种特发性内耳疾病，其特征为反复发作的阵发性旋转性眩晕、波动性听力损失、耳鸣和耳闷感。内淋巴囊（ES）相关手术主要用于对药物治疗反应不佳的 MD 患者。内淋巴导管阻塞（EDB）是一种新的 MD 治疗方法，相关的临床研究仍然较少。本研究旨在探讨 EDB 治疗 MD 患者的内淋巴积水（EH）动态变化和长期手术效果，并评估不同类型 ES 对内淋巴积水的治疗效果的影响。
对 33 例接受 EDB 的难治性 MD 患者进行回顾性分析。根据其内淋巴囊的形态，将患者分为正常型组（=14）和萎缩型组（=19）。比较两组患者术前、术后眩晕症状、听力、前庭功能和内耳钆增强 MRI 的动态变化。
与萎缩型组相比，正常型组患者完全控制眩晕的比例更高，耳蜗和前庭功能更好，内淋巴与前庭体积比更低（均<0.05）。此外，正常型组 7 例患者发现 EH 逆转，而萎缩型组术后未发现 EH 逆转。
EDB 治疗反应在正常型和萎缩型 MD 患者之间存在差异，提示两种病理类型的内淋巴囊可能具有不同的疾病发病机制。
