Revision endolymphatic sac surgery for recurrent Meniére's disease.

A total of 44 cases of revision endolymphatic sac surgery (RESS) were studied. Overall, results of RESS were comparable to the primary endolymphatic sac surgery (PESS). Furthermore, early failure rate (around 6 months after PESS) is significantly higher compared to late failure (approximately 2 years after PESS). In addition, important revision findings which showed saccular fibrosis and new bone growth in the long-term make possible the theory that there is a difference in pathological locus between early and late failures of PESS. Bulky implant devices (such as inner ear valve) had the effect of retarding new bone growth, which may explain their greater efficacy in PESS. They also preserve sac shape and lumen and thus replacement with a new device is facilitated during RESS. These results emphasize the importance of wider decompression during endolymphatic sac surgery (ESS). A new modified version of the inner ear device is proposed to overcome major drawbacks of the current devices, thus further enhancing the success of ESS.