Endolymphatic sac surgery versus intratympanic gentamicin for the treatment of intractable Ménière's disease: a retrospective review with survey.

OBJECTIVES

1) To review a 10-year experience of endolymphatic sac surgery (ESS) and intratympanic gentamicin (ITG) for intractable Ménière's disease (MD), and 2) to compare preoperative and postoperative outcomes.

DESIGN

Retrospective chart review and survey.

SETTING

Tertiary care center.

PATIENTS: Patients treated with ESS or ITG between 1997 and 2007 at London Health Sciences Centre were eligible for recruitment.

INTERVENTIONS: ESS or ITG.

MAIN OUTCOMES: 1) 1995 American Academy of Otolaryngology-Head and Neck Surgery hearing stage, vertigo class, and functional level; and 2) a 40-item validated quality-of-life questionnaire (MD Outcome Questionnaire).

STATISTICAL ANALYSES: Chi-squared and t tests.

RESULTS

Sixty-seven patients were recruited (n = 30 ESS; n = 37 ITG). Preoperatively, the ITG group had poorer hearing stage (p = 0.03). There were no differences between groups on preoperative functional level and QOL measures. Postoperatively, ESS patients reported more tinnitus (p = 0.003) and aural fullness (p = 0.01). There were no differences in posttreatment vertigo class. Secondary treatment was required for 27% of patients in the ESS compared with 3% in the ITG. Posttreatment hearing remained unchanged for the ITG and was overall decreased in the ESS group (p = 0.03). Participants in the ITG reported better postoperative functional levels (p = 0.02) and higher global (p = 0.04), social (p = 0.001), and overall QOL scores (p = 0.03).

CONCLUSION

ITG, compared with ESS, reveals better posttreatment functional levels, and superior global, social, and overall QOL scores. Although no statistical difference in vertigo class, a clinical difference is observed.