10-Year Review of Endolymphatic Sac Surgery for Intractable Meniere Disease

Objective: To review our 10-year experience of endolymphatic sac surgery (ESS) for intractable Meniere disease (MD). Design: Retrospective chart review and survey. Setting: Tertiary care centre. Methods: Patients presenting for ESS from 1998 to 2007 were reviewed using the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. A quality of life (QOL) questionnaire was mailed out using the Dillman method. Main Outcome Measures: (1) 1995 AAO-HNS hearing stage, vertigo class, and functional level; (2) complications and secondary treatments; (3) a 40-question, disease-specific, validated QOL questionnaire (Meniere's Disease Outcome Questionnaire). Results: Thirty patients (33 ears) had ESS (63.6% male, mean age 49 years, mean follow-up 30.6 months). Vertigo control was 35.5% class A, 29.0% class B, 6.5% class C, 0% class D, 3.2% class E, and 25.8% class F. If class A and B are considered successful, then 64.5% were successful. Hearing stage improved in 14.8%, remained the same in 51.9%, and worsened in 33.3%. Average preoperative functional level was 4.3 and postoperative level was 3.5 (p = .0016). Secondary treatment after ESS was performed in 26%. Three patients (10.0%) had profound sensorineural hearing loss. Twenty-five questionnaire responses (75.8%) were received. There was a significant increase in QOL scores (p = .000001), and 80% had an improvement in QOL scores. Conclusions: ESS is a surgical option for MD that offers relief from vertigo in selected patients, but patients need to be cautioned about the risk of hearing loss and the requirement for subsequent destructive treatment in a significant proportion of cases.