A comparison of endolymphatic shunt surgery and intratympanic gentamicin for meniere's disease

A comparison of endolymphatic shunt surgery and intratympanic gentamicin for meniere's disease:

Objective

To report audiovestibular outcomes following endolymphatic shunt surgery (ELS) and intratympanic gentamicin injections (ITG) in patients with Meniere's disease (MD).

Study Design

Retrospective matched cohort study

Methods

Patients with MD refractory to medical management between 2004 and 2017 were reviewed: 44 patients underwent ELS and had outcomes available, while 27 patients underwent ITG and had outcomes available. Mean follow‐up durations for the ELS and ITG groups were 39.1 and 43.3 months, respectively. Twenty‐six patients from the ELS group and 24 patients from the ITG group were then included in a pretreatment hearing‐ and age‐matched analysis. Main outcome measures were successful control of vertigo, pure‐tone average (PTA; 0.5, 1, 2 and 4 kHz), word recognition score (WRS), and treatment complications.

Results

A matched analysis showed vertigo control rates of 73.1% in the ELS group and 66.8% in the ITG group, which were not significantly different (P = .760). The change in PTA following treatment was statistically similar between the ELS group (6.2 dB) and ITG group (4.6 dB) (P = .521), while the change in WRS for the ELS group (+3.9 %) was significantly more favorable than the ITG group (‐13.6 %) (P = .046). Chronic post‐treatment unsteadiness was reported in 25.0% of the ITG group and was not encountered in the ELS group (P = .009).

Conclusion

ELS provided successful vertigo control at least as well as ITG with a lower incidence of audiovestibular complications.

Level of Evidence

4 Laryngoscope, 2019