HSC Section 8_April 2017

ENDOLYMPHATIC SAC SURGERY FOR ME´ NIE` RE _ S DISEASE

FIG. 2. Vertigo control: Forest plot for endolymphatic sac de- compression with Category A/B vertigo control at a minimum of 12 months of follow-up.

FIG. 4. Vertigo control: Forest plot for mastoid shunt (including both with and without silastic sheeting) with Category A/B vertigo control at a minimum of 12 months of follow-up. +ss indicates with silastic sheeting; j ss, without silastic sheeting.

1) ‘‘endolymphatic sac surgery for Me´nie`re’s disease’’; 2) ‘‘endolymphatic sac surgery’’; 3) ‘‘surgery for Me´nie`re’s dis- ease’’; 4) MeSH ‘‘Me´nie`re’s disease/surgery.’’ This resulted in a total of 4,262 abstracts and manuscripts that were subjected to our inclusion and exclusion criteria (Fig. 1A). Our search is graphi- cally depicted in an algorithmic format (Fig. 1B). Endpoints Primary endpoint defined as postoperative vertigo control was evaluated using the AAO-HNS guidelines (1,2). Categories A/B were grouped together and represented either ‘‘complete vertigo control’’ or ‘‘substantial vertigo control.’’ These categories were combined because Category B is generally viewed as a success as it represents a substantial reduction (99% Y 60%) in vertigi- nous attacks. Also, patients with Category B vertigo control typically report great improvement in quality of life and func- tional level (29). Secondary endpoint defined as postoperative hearing preser- vation was evaluated using the AAO-HNS guidelines (1,2). Mean

pure-tone audiometry (PTA) threshold changes were calculated and were categorized either as ‘‘improved’’/‘‘stable’’ (postoper- ative thresholds within 10 dB of preoperative levels) or ‘‘wors- ened’’ (postoperative levels 9 10 dB of preoperative levels). Further, weighted mean PTA $ dB (500, 1,000, and 2,000 Hz) was calculated for each ESS subtype. Both primary and secondary endpoints were evaluated for short-term and long-term results, defined as more than 12 and more than 24 months of follow-up, respectively. Data Extraction Data from studies meeting inclusion and exclusion criteria were extracted and verified by a second author. Information extracted from each study included author, year of publication, number of patients studied, mean length of follow-up, and any reported preoperative and postoperative outcomes.

FIG. 3. Hearing outcomes: Forest plot for endolymphatic sac decompression with hearing improved or stable at a minimum of 12 months of follow-up.

FIG. 5. Hearing outcomes: Forest plot for mastoid shunt (including both with and without silastic sheeting) with hearing improved or stable at a minimum of 12 months of follow-up.

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