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Endolymphatic sac surgery for Ménière's disease: long-term results after primary and revision surgery.

OBJECTIVE: To analyze the results of primary and revision endolymphatic sac surgery for the treatment of Ménière's disease in patients who failed medical therapy.

DESIGN: Retrospective medical chart review.

SETTING: Tertiary referral center.

PATIENTS: Fifty-one adult patients with Ménière's disease who failed medical therapy.

INTERVENTIONS: Endolymphatic sac to mastoid shunts were performed. Revision sac procedures were performed in patients who developed clinically significant recurrent vertiginous spells 5 months or longer after their original procedure.

MAIN OUTCOME MEASURES: Frequency of major vertiginous episodes measured by the standards listed in the 1995 American Academy of Otolaryngology guidelines for evaluation of therapy in Ménière's disease.

RESULTS: Twenty-four months after primary sac surgery, 27 patients (53%) exhibited class A results (no vertigo), and 12 (24%) exhibited class B results (1%-40% of baseline). In 14 patients undergoing revision sac surgery, 5 (36%) showed class A results and 4 (29%) showed class B results. Patients who failed treatment with sac surgery more than 24 months after their primary procedure obtained better results than those who failed treatment less than 24 months after their initial sac procedure. In the 37 patients who had long-term follow-up (mean duration of follow-up, 88 months) after their last sac procedure, 57% exhibited class A results (21 cases) and 35% exhibited class B results (13 cases).

CONCLUSIONS: Endolymphatic sac surgery provided improvement in major spells of vertigo in 77% of patients at 24 months after surgery. Revision surgery provided improvement in 65% of cases. Results of revision surgery were better in those patients who developed recurrent symptoms more than 24 months after their original procedure compared with those of patients who failed treatment earlier.

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