title: Endolymphatic sac surgery versus tenotomy of the stapedius and tensor tympani muscles in the management of patients with unilateral definite Meniere's disease.
abstract: This study aims to compare the outcomes of patients with Meniere's disease submitted to either endolymphatic mastoid shunt (ES) or tenotomy of the stapedius and tensor tympani muscles (TSTM). This is a retrospective chart review of patients treated with ES or TSTM between 2000 and 2010 and followed up for at least 12 months. The main outcomes were represented by: (1) vertigo class, hearing stage and functional level according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; (2) adjustment of dizziness handicap inventory (DHI) and (3) complete and substantial vertigo control using the Kaplan-Meier survival method. Sixty-three patients met the inclusion criteria: 34 underwent ES and 29 TSTM. The baseline demographic characteristics, the hearing stage, the functional level, the DHI and hearing levels were not different between the two groups. No significant difference in vertigo class was demonstrated: 66 % of TSTM patients attained class A compared to 44 % in the ES group (p = 0.14). Kaplan-Meier survival curves specific to class A showed significant differences, favoring TSTM (log-rank test, p = 0.022). TSTM patients demonstrated significantly improved functional level (p = 0.0004) and improved DHI scores (p = 0.001). Eight ES patients (25 %) demanded a second surgical attempt compared to none in the TSTM. Aural fullness was significantly improved in TSTM group (p = 0.01), while the difference in tinnitus improvement was non-significant. Hearing preservation was significantly better in TSTM group (p = 0.001). TSTM is a safe surgical procedure, with significant vertigo control rates, and important hearing preservation rates. More patients and longer follow-up are needed to support our preliminary findings.
authors.affiliation: II-nd Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Str. Republicii nr. 18, 400015, Cluj-Napoca, Romania. silviualbu63@gmail.com.
authors.forename: Silviu
authors.initials: S
authors.lastname: Albu
authors.affiliation: Operative Unit of Otolaryngology and Otosurgery, Padua University, Padua, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Babighian
authors.affiliation: Otology Department, Hospital Dolo-Mirano, Veneto, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Amadori
authors.affiliation: Otology and Skull Base Surgery Unit, Siena University Hospital, Siena, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Trabalzini
mesh_terms: D000328:Adult; D057186:Comparative Effectiveness Research; D019299:Decompression, Surgical / Q000379:methods; D019468:Disease Management; D004712:Endolymphatic Sac / Q000473:pathology / Q000601:surgery*; D004713:Endolymphatic Shunt / Q000009:adverse effects / Q000379:methods; D005260:Female; D006320:Hearing Tests / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008575:Meniere Disease / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013198:Stapedius / Q000473:pathology / Q000601:surgery*; D058971:Tenotomy / Q000009:adverse effects / Q000379:methods; D013719:Tensor Tympani / Q000473:pathology / Q000601:surgery*; D014717:Vertigo / Q000209:etiology / Q000601:surgery
keywords: Endolymphatic mastoid shunt; Meniere’s disease; Survival curves; Tenotomy of the stapedius; Tensor tympani muscles; Vertigo control