title: Endolymphatic sac surgery versus intratympanic gentamicin for the treatment of intractable Ménière's disease: a retrospective review with survey.
abstract: OBJECTIVE
  1) To review a 10-year experience of endolymphatic sac surgery (ESS) and intratympanic gentamicin (ITG) for intractable Ménière's disease (MD), and 2) to compare preoperative and postoperative outcomes.
  
  
  METHODS
  Retrospective chart review and survey.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Patients treated with ESS or ITG between 1997 and 2007 at London Health Sciences Centre were eligible for recruitment.
  
  
  METHODS
  ESS or ITG.
  
  
  RESULTS
  1) 1995 American Academy of Otolaryngology-Head and Neck Surgery hearing stage, vertigo class, and functional level; and 2) a 40-item validated quality-of-life questionnaire (MD Outcome Questionnaire).
  
  
  METHODS
  Chi-squared and t tests.
  
  
  RESULTS
  Sixty-seven patients were recruited (n = 30 ESS; n = 37 ITG). Preoperatively, the ITG group had poorer hearing stage (p = 0.03). There were no differences between groups on preoperative functional level and QOL measures. Postoperatively, ESS patients reported more tinnitus (p = 0.003) and aural fullness (p = 0.01). There were no differences in posttreatment vertigo class. Secondary treatment was required for 27% of patients in the ESS compared with 3% in the ITG. Posttreatment hearing remained unchanged for the ITG and was overall decreased in the ESS group (p = 0.03). Participants in the ITG reported better postoperative functional levels (p = 0.02) and higher global (p = 0.04), social (p = 0.001), and overall QOL scores (p = 0.03).
  
  
  CONCLUSIONS
  ITG, compared with ESS, reveals better posttreatment functional levels, and superior global, social, and overall QOL scores. Although no statistical difference in vertigo class, a clinical difference is observed.
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Western, London, Canada.
authors.forename: Josee
authors.initials: J
authors.lastname: Paradis
authors.forename: Amanda
authors.initials: A
authors.lastname: Hu
authors.forename: Lorne S
authors.initials: LS
authors.lastname: Parnes
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004712:Endolymphatic Sac / Q000601:surgery*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use*; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014432:Tympanic Membrane
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins