HSC Section 8_April 2017

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

TABLE 1. Summary of endolymphatic sac surgery procedures with Category A/B vertigo control in the short term ( 9 12 mo)

Procedure

Mean weighted follow-up (mo)

Category A/B vertigo control

79.3% a , b 76.4% a 76.9% c 75.0% b , c

Sac decompression

26.2 31.0 28.3 31.1

Mastoid shunt ( with and ithout silastic)

Mastoid with silastic Mastoid without silastic

a Sac decompression versus mastoid shunt (with and without silastic) Category A/B vertigo control; p = 0.34. b Sac decompression versus mastoid shunt without silastic Category A/B vertigo control; p = 0.21. c Mastoid shunt with silastic versus Mastoid shunt without silastic Category A/B vertigo control; p = 0.47.

were included in our statistical analysis (12 Y 14,16 Y 22, 25,32 Y 56).

of patients (Fig. 5). Mean PTA worsened by 7.2 dB (range, 0.0 Y 13.3 dB).

Mastoid Shunt With Silastic Versus Mastoid Shunt without Silastic Mastoid With Silastic. Vertigo: Fourteen articles, total- ing 917 patients, were analyzed to determine the efficacy of mastoid shunting with silastic sheeting in controlling ver- tigo. Mean follow-up was 28.3 months (range, 12 Y 51 mo). Complete or substantial (Category A/B) vertigo control was achieved in 76.9% (95% CI, 69.1% Y 83.9%) of pa- tients (Fig. 6). Hearing: Eleven articles, totaling 427 patients, were analyzed to determine the efficacy of mastoid shunting with silastic sheeting in hearing preservation. Mean follow-up was 32.5 months (range, 12 Y 132 mo). Post- operative hearing was stable or improved in 68.0% (95% CI, 62.7% Y 72.1%) of patients (Fig. 7). Mean PTA worsened by 7.2 dB (range, 0.0 Y 13.3 dB). Mastoid Without Silastic. Vertigo : Five articles, total- ing 467 patients, were analyzed to determine the efficacy of mastoid shunting without silastic in controlling verti- go. Mean follow-up was 31.1 months (range, 12 Y 72 mo). Complete or substantial (Category A/B) vertigo control was achieved in 75.0% (95% CI, 58.6% Y 88.5%) of pa- tients (Fig. 8). Hearing: Three articles, totaling 372 patients, were ana- lyzed to determine the efficacy of mastoid shunting with- out silastic in hearing preservation. Mean follow-up was 32.6 months (range, 12 Y 72 mo). Postoperative hearing was unchanged or improved in 72.5% (95% CI, 59.4% Y 84.9%) of patients (Fig. 9). Mean PTA worsened by 13.3 dB (only value, no range).

Short-term Analysis

Endolymphatic Sac Decompression Versus Mastoid Shunt

Endolymphatic Sac Decompression. Vertigo : Six arti- cles, totaling 267 patients, were analyzed to determine the efficacy of endolymphatic sac decompression in control- ling vertigo. Mean follow-up was 26.2 months (range, 12 Y 55mo). Complete or substantial (Category A/B) vertigo control was achieved in 79.3% (95% CI, 62.9% Y 91.9%) of patients (Fig. 2). Hearing: Eight articles, totaling 303 patients, were ana- lyzed to determine the efficacy of endolymphatic sac de- compression in hearing preservation. Mean follow-up was 25.8 months (range, 12 Y 55 mo). Postoperative hearing was stable or improved in 72.8% (95% CI, 62.5% Y 81.9%) of patients (Fig. 3). Mean PTA worsened by 1.3 dB (range, j 1.4 to 9.6 dB). Mastoid Shunts (With and Without Silastic). Vertigo : Nineteen articles, totaling 1,384 patients, were analyzed to determine the efficacy of current mastoid shunting pro- cedures in controlling vertigo symptoms. Mean follow-up was 31.0 months (range, 12 Y 72 mo). Complete or sub- stantial (Category A/B) vertigo control was achieved in 76.4% (95% CI, 69.5% Y 82.7%) of patients (Fig. 4). Hearing: Fourteen articles, totaling 799 patients, were an- alyzed to determine the efficacy of current mastoid shunting procedures in hearing preservation. Mean follow-up was 34.8 months (range, 12 Y 132 mo). Postoperative hearing was stable or improved in 71.4% (95% CI, 64.9% Y 77.5%)

TABLE 2. Summary of endolymphatic sac surgery procedures of hearing preservation in the short term ( 9 12 mo)

Procedure

Mean weighted follow-up (mo)

Hearing stable/improved (%)

$ PTA (dB; hearing worsened)

72.8% a , b , c 71.4% a 68.0% c , d 72.5% b , d

Sac decompression

25.8 34.8 32.5 32.6

1.3 7.2 7.2 n/a

Mastoid shunt ( with and without silastic)

Mastoid with silastic Mastoid without silastic

a Sac decompression versus mastoid shunt (with and without silastic) hearing stable/improved; p = 0.69. b Sac decompression versus mastoid shunt without silastic hearing stable/improved; p = 0.99. c Sac decompression versus mastoid shunt with silastic hearing stable/improved; p = 0.18. d Mastoid shunt with silastic versus mastoid shunt without silastic hearing stable/improved; p = 0.004. PTA indicates pure-tone audiometry.

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