| ObjectiveTo investigate the clinical efficacy of retrosigmoid vestibular neurotomy and Endolymphatic sac surgery for treatment of Meniere's disease.To evaluate outcomes,indications,complications and follow up results. To analyse possible treatment machanism.Materials and methodsPatients were chosen from the ENT Department of Shandong Provincial hospital froml983 to 2003. acquired integrity material 98 cases. Endolymphatic sac surgery was done in 63 cases and retrosigmoid vestibular neurotomy was operated on 35 cases. The choice of surgical measures was mainly according to the patients hearing level.Has the practical hearing,first choice was endolymphatic sac surgery;Does not have the practical hearing, first choice was retrosigmoid vestibular neurotomy. If the endolymphatic sac surgery was defeated or the vertigo seriously affects the patient quality of life, patient have to be treated with retrosigmoid vestibular neurotomy. Using the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium criteria,starting stage, functional level, vertigo class, and hearing results were addressed. All cases werefollowed up for 2-20 years. Patient data were gathered by retrospective chart review, questionnaire, and patient interview. The treatment results were evaluated by vertigo control,hearing situation and functional level.ResultsComplete relief from symptoms of vertigo occurred in the 33 cases through vestibular neurotomy . vertigo control was complete in 94% of the patients .One hundred percent of patients showed improvement in functional level. Eighty four percent of patients showed declined in hearing class.28 of 63 cases with endolymphatic sac surgery had complete control of vertigo and were cured clinically. Sixty-six percent of patients showed improvement in functional level. Eleven percent of patients showed improved in hearing class, 57% were stable, and 32% declined.ConclusionEndolymphatic sac surgery and retrosigmoid vestibular neurotomy are effective way for control of vertigo of patients with intractable Meniere"s disease. Endolymphatic sac surgery is a safe, nondestructive surgical option for Meniere's disease that offers stabilization of hearing for the majority of symptomatic patients, vestibular neurotomy are more effective for control of vertigo for appropriately selected patients. The operation of vestibular neurectomy should be adopted only in the patients who have failed after the operation of endolymphatic sac surgery or have lost the working ability substantially. |
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