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Vestibular nerve section and saccus decompression: An evaluation of long-term results

Published online by Cambridge University Press:  29 June 2007

W. J. Primrose ,
G. D. L. Smyth ,
A. G. Kerr  and
D. S. Gordon
W. J. Primrose*
Affiliation:
Belfast
G. D. L. Smyth
Affiliation:
Belfast
A. G. Kerr
Affiliation:
Belfast
D. S. Gordon
Affiliation:
Consultant Neurosurgeon, Royal Victoria Hospital, Belfast.
*
William J. Primrose, F.R.C.S., Senior Registrar in Otolaryngology, Department of Otorhinolaryngology, Eye and Ear Clinic, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland.
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Abstract

The 1972 AAOO committee (Alford, 1972) guidelines brought some uniformity into the evaluation of therapy for Meniere's Disease. We have adhered to its recommendations in this long-term follow-up report of 21 saccus decompressions and 29 vestibular nerve sections performed on 46 patients between 1968 and 1977. Comparisons between these and other groups have been possible with regard to: 1. control of vertigo; 2. hearing; 3. tinnitus; and 4. development of hydrops in the contralateral ear. All the vestibular nerve section group have enjoyed sustained relief from vertigo. Class D results (recurrent vertigo) account for 14 per cent of the saccus decompression group at one year and 29 per cent at eight to 10-year follow-up. Hearing levels in both groups deteriorated in parallel as time progressed but tinnitus became less noticeable. Nineteen per cent of the long-term review patients showed evidence of developing cochlear hydrops in the contralateral ear. Conservative surgical procedures should be employed whilst any useful hearing exists, though the emphasis remains on controlling vertigo. Saccus decompression, despite its controversial therapeutic basis, will remain the first-line surgical procedure for many otologists. However, in the fit young Meniere's cripple or saccus decompression failure with serviceable hearing, vestibular nerve section remains the treatment of choice.

Type
Research Article
Information
The Journal of Laryngology & Otology , Volume 100 , Issue 7 , July 1986 , pp. 775 - 784
Copyright
Copyright © JLO (1984) Limited 1986

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References

Alford, B. R. (1972) Menière's Disease: criteria for diagnosis and evaluation of therapy for reporting. Transactions of the American Academy of Ophthalmology and Otolaryngology, 76: 1462–1464.Google Scholar
Arenberg, I. K., and Stahle, J. (1979) Staging the aural aspects of Menière's Disease. Laryngoscope, Supplement 17, 89: 40.CrossRefGoogle ScholarPubMed
Arenberg, I. K., Brandenburg, J. H., Saver, R. C., and Kaemmerle, A. W. (1980) Reporting results in Menière's Disease according to the 1972 AAOO criteria. Otolaryngologic Clinics of North America, 13: 681.CrossRefGoogle Scholar
Balkany, T. J., Sires, B., and Arenberg, I. K. (1980) Bilateral aspects of Menière's Disease: an underestimated clinical entity. Otolaryngologic Clinics of North America, 13: 603–609.CrossRefGoogle ScholarPubMed
Belal, A. Jr., Linthicum, F. H. Jr., and House, W. F. (1979) Middle fossa vestibular nerve section. American Journal of Otology, 1: 72–79.Google ScholarPubMed
Brackmann, D. E., and Anderson, R. G. (1980) Menière's Disease: treatment with the endolymphatic subarachnoid shunt, a review of 125 cases. Otolaryngology, Head and Neck Surgery, 88: 774–782.CrossRefGoogle ScholarPubMed
Brown, J. S. (1983) A ten year statistical follow-up of 245 consecutive cases of endolymphatic shunt and decompression with 328 consecutive cases of labyrinthectomy. Laryngoscope, 93: 1419–1425.CrossRefGoogle Scholar
Fisch, U. (1970) Transtemporal surgery of the internal auditory canal: report of 92 cases, techniques, indications and results. Advances in Otorhinolaryngology, 17: 202.Google Scholar
Glasscock, M. E., Kveton, J. F., and Christiansen, S. G. (1984) Current status of surgery for Menière's Disease. Otolaryngology, Head and Neck Surgery, 92: 67–72.CrossRefGoogle ScholarPubMed
Glorig, A., and Gallo, R. (1962) Comments on sensorineural hearing loss in otosclerosis. International Symposium in Otosclerosis, Henry Ford Hospital, Detroit, pp. 63–78. Little Brown and Company, Boston, Massachusetts.Google Scholar
Goldenberg, R. A., and Justus, M. A. (1983) Endolymphatic mastoid shunt for treatment of Menière's Disease: a five-year study. Laryngoscope, 93: 1425–1429.CrossRefGoogle ScholarPubMed
Greven, A. J., and Oosterveld, W. J. (1975) The contralateral ear in Menière's Disease. Archives of Otolaryngology, 101: 608–612.CrossRefGoogle Scholar
Guild, S. R. (1927) The circulation of the endolymph. American Journal of Anatomy, 39: 57–81.CrossRefGoogle Scholar
House, W. F. (1961) Surgical exposure of the internal auditory canal and its contents through the middle cranial fossa. Laryngoscope, 71: 1363–1365.CrossRefGoogle ScholarPubMed
Lake, R. (1904) Removal of the semi-circular canals in a case of unilateral aural vertigo. Lancet, 1: 1567–1568.CrossRefGoogle Scholar
Morrison, A. W. (1983) Sac surgery on the only or better hearing ear. Otolaryngologic Clinics of North America, 16: 1. 143–141.CrossRefGoogle ScholarPubMed
Morrison, A. W. (1985) Predictive tests for Menière's Disease. Personal communication.Google Scholar
Naftalin, L., and Harrison, M. S. (1958) Circulation of labyrinthine fluids. Journal of Laryngology and Otology, 72: 118–136.CrossRefGoogle ScholarPubMed
Palva, T., Ylikoski, J., Paavolainen, M., Holopainen, E., and Jauhiainen, T. (1979) Vestibular neurectomy and saccus decompression surgery in Menières Disease. Acta Otolaryngologica, 88: 74–78.CrossRefGoogle Scholar
Parry, R. H. (1904) A case of tinnitus and vertigo treated by division of the auditory nerve. Journal of Laryngology and Otology, 19: 402.CrossRefGoogle Scholar
Schuknecht, H. F. (1977) Pathology of Menière's disease as it relates to sac and tack procedures. Annals of Otology, Rhinology and Laryngology, 86: 677–682.CrossRefGoogle ScholarPubMed
Shambaugh, G. E. (1966) Surgery of the endolymphatic sac. Archives of Otolaryngology, 83: 305–316.CrossRefGoogle ScholarPubMed
Smyth, G. D. L., Hassard, T. H., and Kerr, A. G. (1981) The surgical treatment of vertigo: the essentials of patient selection and long-term results. American Journal of Otology, 2: 179–187.Google ScholarPubMed
Smyth, G. D. L., Houlihan, F. P., and Hassard, T. (1977) Twelve years' experience in the surgical treatment of vertigo. Journal of Laryngology and Otology, 91: 1013–1031.CrossRefGoogle ScholarPubMed
Smyth, G. D. L., Kerr, A. G., and Gordon, D. S. (1976) Vestibular nerve section for Menière's Disease. Journal of Laryngology and Otology, 91: 823–831.CrossRefGoogle Scholar
Spector, G. J., and Smith, P. G. (1983) Endolymphatic sac surgery for Menière's Disease. Annals of Otology, Rhinology and Laryngology, 92: 113–118.CrossRefGoogle ScholarPubMed
Stahle, J. (1976) Advanced Menière's Disease, a study of 356severely disabled patients. Acta Otolaryngologica, 81: 113–119.CrossRefGoogle ScholarPubMed
Thomas, K., and Spencer-Harrison, M. (1971) Long-term follow-up of 610 cases of Menière's Disease. Proceedings of the Royal Society of Medicine, 64: 853–856.CrossRefGoogle ScholarPubMed
Thomsen, J., Bretlau, P., Tos, M., and Johnston, N. J. (1981) Placebo effect in surgery for Menière's Disease. Archives of Otolaryngology, 107: 271–277.CrossRefGoogle Scholar
Vernon, J., Johnson, R., and Schleuning, A. (1980) The characteristics and natural history of tinnitus in Menière's Disease. Otolaryngologic Clinics of North America, 13: 4, 611–619.CrossRefGoogle ScholarPubMed