Curative Effect Of Semicircular Canal Occlusion On Meniere’s Disease And The Change Of Endolymphatic Hydrops Before And After Operation And Its Clinical Correlation

Objective:To analyze the effect of semicircular canal occlusion(SCO)in the treatment of refractory Meniere’s disease(MD),and to evaluate endolymphatic hydrops(EH)before and after SCO in patients with MD by using magnetic resonance imaging(MRI).To further investigate the correlation between the change of EH and the control of clinical signs and symptoms in patients with refractory Meniere’s disease treated with SCO.Method:From May 2020 to December 2022,20 patients with refractory Meniere’s disease who failed to respond to conservative treatment were selected from the Department of Otolaryngology,Head and Neck Surgery,The First Affiliated Hospital of Nanchang University.All the 20 patients were diagnosed as unilateral Meniere’s disease,and the presence of EH was confirmed by MR inner ear gadolinium imaging after preoperative tympanic or intravenous injection of gadolinium pentanoate meglumine contrast agent.The patients were followed up for 6 to 24 months(mean,13.9±5.7 months),and MR gadolinium imaging was performed again.The degree of cochlear and vestibular EH was evaluated by Bernaerts’ visual scoring method on MRI images of 20 patients with Meniere’s disease,and the changes of EH and semicircular canal obstruction were observed.The hearing,vertigo,tinnitus grading and vestibular double temperature test of 20 patients before and after operation were compared and analyzed.In order to evaluate the efficacy of semicircular canal occlusion in the treatment of Meniere’s disease,and compare and analyze the correlation between the changes of EH before and after the operation and the control of clinical symptoms.Results:The control rate of vertigo in 20 patients with Meniere’s disease was 100%,including 17 cases of grade A(85%)and 3 cases of grade B(15%);Hearing loss occurred in 8 cases(40%),no change in 11 cases(55%)and improvement in 1 case(5%);There were 16 cases(80%)whose tinnitus had no change,4 cases(20%)whose tinnitus had improved,and no obvious aggravation of tinnitus was found.The vestibular EH of 17 cases(85%)had no obvious change after operation;Vestibular EH was improved in 2 patients(10%);Vestibular EH was aggravated in 1 patient(5%).Seventeen patients(85%)had no significant changes in cochlear EH;One patient(5%)had complete improvement of cochlear EH;Two patients(10%)had cochlear EH aggravation.Postoperative magnetic resonance imaging(MRI)of the inner ear showed that the semicircular canals of 20 patients were successfully occluded,and the vestibular test showed that the function of the semicircular canals was lower or disappeared after operation.Conclusion:1.Semicircular canal occlusion can control vertigo in patients with refractory Meniere’s disease and does not aggravate tinnitus,but it has a certain risk of hearing loss.2.Most of the patients had no obvious signs of EH changes in MRI after operation.And there was no significant correlation between the changes of vertigo,tinnitus and hearing level in MD patients after operation and the changes of EH,suggesting that the changes of vertigo,tinnitus and hearing level can not be attributed to the relief of EH.