Histopathology After Endolymphatic Sac Surgery for Meniere's Syndrome

Massachusetts Eye and Ear and Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Impact Factor: 1.79). 03/2011; 32(4):660-4. DOI: 10.1097/MAO.0b013e31821553ce
Source: PubMed


The putative goal of sac surgery in Ménière's syndrome is to promote the flow of endolymph from the labyrinth to the endolymphatic sac and thereby relieving hydrops. There are scant published histopathologic data whether sac surgery actually accomplishes this goal.
To determine whether sac surgery relieves hydrops by examining the histopathologic changes in temporal bones obtained from individuals who had undergone sac surgery during life for Ménière's syndrome.
Temporal bones were examined from 15 patients who had sac surgery. Data on the presence and severity of hydrops, histology of the sac, and whether the procedure relieved vertigo were collected.
The surgery failed to expose the sac in 5 cases; 4 of the 5 had relief from vertigo. The sac was exposed, but the shunt failed to reach the lumen of the sac in 8 cases; 4 of the 8 had relief from vertigo. The shunt was successfully placed within the lumen of the sac in 2 cases; both cases failed to experience relief from vertigo. Endolymphatic hydrops was present in all 15 cases.
Endolymphatic sac surgery does not relieve hydrops in patients with Ménière's syndrome. Yet, sac surgery relieves vertigo in some patients, but the mechanism of such symptomatic relief remains unknown.


Available from: Fred H Linthicum, Mar 12, 2014

  • Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 12/2011; 33(1):96. DOI:10.1097/MAO.0b013e31823c91bb · 1.79 Impact Factor
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    ABSTRACT: The cause of Meniere's disease is unknown. The postmortem examination of the temporal bone reveals an "endolymphatic hydrops" of the inner ear. Classically, patients describe episodes of vertigo, fluctuations of hearing and tinnitus. But some report "strange stories" that deserve doctor's attention. This article explains why their history (as those suffering from any other vestibular disorder) is often particular, to recall the few knowledge of the disease, how the endolymphatic hydrops was considered as the cause of the disorder, while it is rather an epiphenomenon, and to show how one can believe, wrongly, that a therapy is efficient after a study that seems however at first correctly performed.
    Revue médicale suisse 10/2012; 8(356):1872-5.
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    ABSTRACT: Conclusion: Endolymphatic hydrops could be a reversible inner ear pathological condition. After sac surgery, hydrops was reduced and symptoms went into remission in some cases, although vertigo suppression was not always a result of the reduced hydrops. Objective: To examine the changes in endolymphatic hydrops detected by gadolinium (Gd) contrast-enhanced magnetic resonance imaging (MRI) before and 6 months after endolymphatic sac surgery in patients with unilateral Ménière's disease. Methods: Fluid-attenuated inversion recovery MRI was obtained 4 h after intravenous administration or 24 h after intratympanic administration of Gd contrast medium. An enlarged negative stain corresponding to the cochlear duct and endolymphatic space of the vestibule was assessed as hydrops. Results: Of seven patients with hydrops confirmed by MRI before surgery, both cochlear and vestibular hydrops became negative in two, cochlear hydrops became negative in one, both hydrops were present, but reduced, in one, and there was no change in three patients. The number of vertigo spells was reduced in all cases at 6-12 months after surgery. As for the three cases of negative hydrops, vertigo was completely suppressed. In two cases in which hearing level improved, hydrops became negative after surgery.
    Acta oto-laryngologica 06/2013; 133(9). DOI:10.3109/00016489.2013.795290 · 1.10 Impact Factor
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