Korean J Otorhinolaryngol-Head Neck Surg.  2022 Nov;65(11):669-677. 10.3342/kjorl-hns.2021.00836.

A Comparison of Endolymphatic Sac Decompression and Intratympanic Gentamicin for Treatment of Meniere’s Disease

• Joo HA
• Jeong IS
• Kang WS
• Park HJ
• Chung JW
• Ahn JH

• KMID: 2536181
• DOI: http://doi.org/10.3342/kjorl-hns.2021.00836

Abstract

Background and Objectives
Meniere’s disease (MD) is primarily managed by lifestyle and dietary changes. There are several non-medical treatment options for medically intractable MD; however, treatment results still remain controversial. This study aims to review the treatment outcome of endolymphatic sac decompression (ESD) and intratympanic gentamicin (ITG) for MD refractory to medical management.
Subjects and Method
The medical records of 50 patients, diagnosed with definite MD intractable to medical management, who underwent ESD or ITG from 2010 to 2020 at a tertiary referral hospital, were retrospectively reviewed. ESD was first considered in patients with serviceable hearing (pure tone audiometry average value less than 50 dB, speech discrimination score of 50% or greater). One-year post-treatment audiological changes and vertigo control were reviewed and compared between the two groups.
Results
Fifty patients (ears) were enrolled in this study (ESD, n=27; ITG, n=23). There was a post-treatment hearing gain (2.3 dB HL) in the ESD group (p=0.509), while there was an overall post-treatment hearing decline (2.2 dB HL) in the ITG group (p=0.178), with no significant difference between two groups regarding hearing change (p=0.212). Regarding vertigo control, 66.6% and 56.5% patients in the ESD and ITG groups, respectively, were classified as vertigo class A or B, with statistically significant difference between both groups (p=0.027).
Conclusion
ESD conferred better post-treatment vertigo control than ITG, but there were no significant hearing changes in both groups. ESD is an effective treatment for patients with medically intractable MD who has serviceable hearing.

Keyword

Endolymphatic sac; Gentamicins; Meniere disease; Vertigo