Endolymphatic sac surgery for Meniére's disease. A cumulative study of twelve years' experience.

This paper analyzes a total of 861 endolymphatic-mastoid shunt procedures (ELS) during 12 years. The review of long-term results following surgery for patients with intractable Meniére's disease indicates that ELS often provides temporary remission of severe disabling symptoms. Overall results, according to AAOO criteria, showed long-term vertigo control in 71.90% of cases. Using AAO-HNS guidelines, vertigo was completely or substantially controlled in 85.89% of the cases. In addition, hearing gains were frequently sustained and hearing deterioration often prevented over the years. A positive dehydration test and/or fluctuating hearing indicate a greater likelihood of hearing improvement after surgery. Furthermore, these findings augment our previous studies that comparable results can be obtained regardless of method employed. Thus, ELS is still indicated as a primary choice of surgical treatment when surgery is mandatory. Finally, there seem to be chronological peaks of recurrence of symptoms at about 2 years and again at 6 or more years after ELS. This not only accentuates the efficacy of revision surgery, but opens new areas of investigation into the underlying etiology of this elusive disease.