Outcomes of endolymphatic shunt surgery for Ménière's disease: comparison with intratympanic gentamicin on vertigo control and hearing loss

M Jennifer Derebery, Laurel M Fisher, Karen Berliner, Janice Chung, Katherine Green
Otology & Neurotology 2010, 31 (4): 649-55

OBJECTIVE: To compare proportions of the combined outcome of vertigo control and hearing preservation between intratympanic gentamicin injections and endolymphatic sac shunt surgery for intractable vertigo in Ménière's disease patients.

STUDY DESIGN: Analysis of published data and retrospective review.

SETTING: Tertiary otologic referral center.

PATIENTS: Patients with Ménière's disease who had failed medical management: 183 surgical patients (shunt group) and 203 patients obtained from 6 published gentamicin treatment studies (gentamicin group). Cases were included if hearing and vertigo data were available before and after treatment with no previous surgical or injection treatment. Average patient age ranged from 45 to 59 years across studies. Gentamicin studies had nearly equal female to male subjects, whereas the shunt group was 60% female.

INTERVENTIONS: Endolymphatic sac shunt surgery or intratympanic gentamicin treatment of differing doses and injection schedules.

MAIN OUTCOME MEASURE: Proportion of patients with best combined vertigo control/hearing preservation. Hearing preservation is 10 dB or less increase in pure-tone average. Outcomes were categorized as follows: complete vertigo control/hearing preservation (best), complete vertigo control/hearing loss, incomplete vertigo control/hearing preservation, and incomplete vertigo control/hearing loss (worst).

RESULTS: The shunt group showed a significantly higher percentage of the best outcome (62%) than the gentamicin group (56%, p <or= 0.003), as well as a higher rate of complete vertigo control (86% versus 71%; p <or= 0.001).

CONCLUSION: A higher percentage of patients undergoing shunt surgery attained complete vertigo control/hearing preservation relative to intratympanic gentamicin. There continues to be significant variability in gentamicin outcomes, suggesting that the technique requires additional refinement before consistently producing good outcomes.

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