Results of endolymphatic sac surgery in advanced Meniere's disease.

A rational surgical approach to Meniere's disease eludes us because of the uncertainty of the pathophysiology and the variability in the natural history of the disease. The results of different surgical techniques are difficult to compare because of differences in patient selection, methods of analysis, and length of follow-up reported. This study reviews long-term results in twenty-four ELS procedures in which the test group and parameters of evaluation are carefully described. The overall rate of vertigo control is 75 percent and incidence of significant hearing improvement is 25 percent. This low rate of hearing improvement is related to the selection of patients with advanced disease and other factors. In this series, surgery limited to simple decompression of the ELS proved generally more effective than shunt procedures. It is noteworthy that the Arenberg valve implant provided impressive results in a small number of revisions. Postoperative fibrosis appears to affect results adversely, therefore, measures to prevent scar tissue proliferation seem indicated.