Contemporary Role of Endolymphatic Mastoid Shunt Surgery in the Era of Transtympanic Perfusion Strategies

Objectives: Although there exist undisputed methods to permanently silence the aberrant end organ, controversy Surrounds the durable efficacy of non-ablative interventions. This study provides a contemporary review of our institution's clinical experience in performing endolymphatic mastoid shunt surgery (EMSS) in patients with medically refractory endolymphatic hydrops, or Meniere's disease. Methods: Between 1984 and 2002, 1,612 patients were referred to our institution with a diagnosis of Meniere's disease. Of these referrals, 1, 172 patients met the criteria for Meniere's disease. Although 553 patients responded to medical management, 486 patients underwent EMSS and 133 patients had refractory disease that required chemical or surgical obliterative interventions. The retrospective study utilizes data collected on 226 patients who were followed for a minimum of 5 years. Results: Overall, 78% patients responded favorably to EMSS, according to the functional level scale and class categories delineated by the American Academy of Otolaryngology-Head and Neck Surgery 1995 guidelines for control of vertigo. According to the Arenberg anatomic classification for endolymphatic sac location, EMSS achieved adequate control of vertigo in 86% of type I cases, 90% of type II cases, and 82% of type III cases. Conclusions: Endolymphatic mastoid shunt surgery is a relatively safe, effective procedure for the long-term control of vertigo in patients with medically refractory Meniere's disease.