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Role of Endolymphatic Sac Decompression in Intractable Meniere’s Disease
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Shin Hye Kim, Jihye Rhee, Yoonjong Ryu, Byung Yoon Choi, Ja Won Koo
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Res Vestib Sci. 2013;12(1):16-21.
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 Abstract
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- Background and Objectives: The role of endolymphatic sac decompression (ELSD) for the treatment of intractable Meniere disease (MD) has been debated. However, considering few treatment options for medically intractable MD with serviceable hearing or intractable bilateral MD, ELSD has shown reasonable treatment results without ablating inner ear function. The aims of this study are to review the role of ELSD in the treatment of MD and clinical course and long-term outcome after ELSD. Materials and Methods: The ELSD was performed in 7 patients among 603 definite Meniere disease patients between May 2003 and December 2010. Patient’s medical history and clinical courses after surgery were obtained by medical record review and telephone interview. Results: Mean duration of follow up until receiving ELSD was 575 days since initial visit. Six patients showed complete control or substantial control of vertigo, but one patient suffered from sustained vertigo attacks even after ELSD, the vertigo was controlled after intratympanic gentamicin injection (ITGI) at 20 months after ELSD. Another patient had recurrence of vertigo after 30 months, which was successfully controlled by ITGI. The preoperatively mean monthly vertigo was 4.8 and it was significantly decreased to 1.5 after postoperatively 1 year, 0 after postoperatively 2 years (p<0.001). Hearing was preserved in 6 patients during the follow-up period. Conclusion: Most patients who were uncontrolled vertigo with 3 to 6 months medication showed significantly reduced vertigo and hearing preservation after ELSD. The ELSD seems to be a beneficial treatment option for intractable MD.
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Head Position Dependency of Induced Nystagmus to Ice Water Irrigation in peripheral vestibulopathy
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Byung Yoon Choi, Ja Won Koo, Seung Ha Oh, Sun O Chang, Chong Sun Kim
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J Korean Bal Soc. 2003;2(2):175-180.
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Abstract
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- Background
s and Objectives: The direction of caloric nystagmus depends on the head position as long as vestibular function is remaining but the it does not depend on head position change in the lateral semicircular canal (SCC) plugged ear, which is attributed to thermoconvection in the lateral SCC. So determination of head position dependency using ice water test is recommended in the evaluation of peripheral vestibulopathy in which dead labyrinth is suspected. Since ice water test in prone position is frequently skipped and neglected in many vestibular laboratories, we investigated the importance and necessity of evaluating head position dependency for the candidates of ice water test and estimated the amount of head position non-dependent component in discussion.
Materials and method: From January through September 2003, 25 patients, who showed no nystagmus during warm irrigation, were included in this study. Following forty milliliter of ice water irrigation in supine & prone position, the maximum slow phase eye velocity (SPEV) and direction of nystagmus were assessed using video nystagmography system.
Result
Eleven cases showed head-position dependency and were interpreted as hypofunction of lateral SCC. Fourteen cases did not show head position dependency suggesting the absence of end organ function. However, in the latter group, 6 patients, who showed definite nystagmus to ice water irrigation in supine position, can be midinterpreted as hypofunction if ice water test in prone position is not performed.
Conclusion
Evaluation of head position dependency in ice water irrigation is an important procedure in the determination of lateral SCC function and can provide valuable information when vestibular ablative procedures are considered.
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KBS
