New Surgery For Meniere's - Endolymphatic Duct Blockage (EBD)

http://www.ncbi.nlm.nih.gov/pubmed/25403881

Endolymphatic Duct Blockage: A Randomized Controlled Trial of a Novel Surgical Technique for Ménière's Disease Treatment.

Saliba I1, Gabra N2, Alzahrani M2, Berbiche D3.



Author information





Abstract

OBJECTIVES:

To compare the effectiveness of the endolymphatic duct blockage (EDB) and the endolymphatic sac decompression (ESD) to control Ménière's disease symptoms and to evaluate their effect on hearing level.

STUDY DESIGN:

Prospective nonblinded randomized study.

SETTING:

Tertiary medical center.

SUBJECTS AND METHODS:

Fifty-seven patients affected by a refractory Ménière's disease were included out of which 22 underwent an ESD and 35 underwent an EDB. Five periods of follow-up were considered: 0 to 1 week, 1 week to 6 months, 6 to 12 months, 12 to 18 months, and 18 to 24 months. Mean outcome measurements consisted of vertigo control, tinnitus, aural fullness, instability, and hearing level. Hearing level was evaluated using pure-tone average (PTA) and speech discrimination score (SDS).

RESULTS:

There was no significant difference between the 2 groups in the number of vertigo spells per months preoperatively (P = .153). Twenty-four months postoperatively, 96.5% of the EDB group had achieved a complete control of vertigo spells against 37.5% of the ESD group with a statistically significant difference (P = .002). There was a better control of tinnitus and aural fullness with EDB (P = .021 and P = .014, respectively). There was no statistically significant difference in hearing level preoperatively (P = .976) and 24 months postoperatively (P = .287) between the 2 groups. Hearing level was preserved in each group with no significant difference between the preoperative and the postoperative levels (P > .05).

CONCLUSION:

EDB is more effective than the traditional ESD in controlling the symptoms of Ménière's disease. It is a novel surgical technique with promising results for a complete treatment of Ménière's disease. There are no significant complications or adverse effect.

© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

 

Thanks BD, it sounds like a good option for those who do not respond to antivirals or other MM treatments.

 

Thank you nicmger and you're so welcome

 

same here BD

 

You're welcome

 

you're welcome. I purchased the full artcle so I will copy and paste:

Surgical Protocol of EDB
First, we performed a canal wall-up mastoidectomy: the
tegmen mastoideum, sigmoid sinus, and sinodural angle are
identified, and the posterior bony ear canal wall is thinned.
We identify the posterior semicircular canal (PSCC) and the
dura matter of the posterior fossa. Using the prominence of
the horizontal semicircular canal, Donaldson line is identified
to approximate the position of the endolymphatic sac

Bone over the sac and the dura are thinned with a diamond
burrs. The sac is completely skeletonized and decompressed.
The infralabyrinthine dura is exposed because the main body
of the sac and its lumen often lie within this area. The sac is
not incised neither dissected off the posterior fossa dura.
These described parts of the surgery are performed for the 2
groups: ESD and EDB. For the ESD group, the sac is completely
decompressed and the surgery is accomplished.
However, for the EDB we continue to dissect the bone of the
vestibular aqueduct operculum and the posterior fossa dura
from the retrolabyrinthine bone medial to the sac around the
endolymphatic duct in order to identify the duct in its superior
and inferior part in continuity from the endolymphatic sac
and create a place to insert the tips of the instrument to clip
the duct. At this level care must be taken not to traumatize
the dura, which is often thin. Finally we block the dissected
endolymphatic duct with 2 small titanium clips (Figure 2).
The titanium clips were applied by using the ligating clip
applier, similar to the 1 used in vascular surgery.
Statistical Analysis

 

no sorry I don't

 

Aww thank you! and you are very welcome!