Endolymphatic duct blockage surgery vs. intratympanic steroids for treatment of refractory Ménière's disease.

Autor: Saliba I; University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC, Canada. issam.saliba@umontreal.ca.; Division of Otolaryngology-Head and Neck Surgery, University of Montreal Hospital Centre (CHUM), 1051 Sanguinet St, Montreal, QC, Canada. issam.saliba@umontreal.ca., Dufour-Fournier C; University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC, Canada.; Division of Otolaryngology-Head and Neck Surgery, University of Montreal Hospital Centre (CHUM), 1051 Sanguinet St, Montreal, QC, Canada., Asmar MH; University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC, Canada.
Jazyk: angličtina
Zdroj: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2024 Oct; Vol. 281 (10), pp. 5159-5167. Date of Electronic Publication: 2024 May 24.
DOI: 10.1007/s00405-024-08736-4
Abstrakt: Purpose: To compare the effectiveness of the Endolymphatic duct blockage (EDB) and intratympanic methylprednisolone(ITMP) injection to control refractory Ménière's disease(MD) symptoms and evaluate their impact on hearing level.
Study Design: Retrospective study in a tertiary care center.
Methods: 36 received ITMP injection and 52 EDB. Mean outcome measures at 24 months included vertigo control, tinnitus, aural fullness and hearing level: pure-tone average (PTA), bone conduction average(BCA) and speech discrimination score(SDS).
Results: At 24 months postoperatively, 90.4% of the EDB group had complete control of vertigo and 43.4% of the ITMP group (p = 0.001). There was no significant difference in tinnitus or aural fullness control (p = 0.34 and p 0.21 respectively). In each group, the drop in tinnitus and aural fullness frequency at 24 months were significant for EDB (p = 0.03; p < 0.001 respectively) and for ITMP group in tinnitus (p = 0.03) but not aural fullness (p = 0.063). At 24 months, PTA, BCA and SDS were significantly worst in the ITMP group when compared to preoperative levels (p = 0.038, p = 0.027, p = 0.016). PTA in the EDB group was stable with no difference compared to ITMP group (p = 0.48). BCA and SDS in the EDB group were stable and better than the ITMP group (p = 0.032; p = 0.036). In each group, vestibular paresis was not significantly different before (p = 0.06) and after treatment (p = 0.68).
Conclusion: EDB is more effective than the ITMP for controlling the vertigo symptoms of Ménière's disease and in preserving hearing function. It is a novel surgical technique with promising results for a complete treatment of Ménière's disease. ITMP decreases the frequency and the severity of the symptoms but only control vertigo in 27.8% of cases.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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