title: Long-term outcomes of endolymphatic sac shunting with local steroids for Meniere's disease.
abstract: OBJECTIVE
  To evaluate the long-term efficacy of endolymphatic sac shunt techniques with and without local steroid administration.
  
  
  METHODS
  Retrospective case series and patient survey.
  
  
  METHODS
  Tertiary university hospital.
  
  
  METHODS
  Meniere's disease (MD) patients that failed medical therapy and subsequently underwent an endolymphatic sac shunt procedure. All patients had definitive or probable MD and at least 18-months of follow-up.
  
  
  METHODS
  Three variations on endolymphatic sac decompression with shunt placement were performed: Group A received no local steroids, Group B received intratympanic dexamethasone prior to incision, and Group C received dexamethasone via both intratympanic injection and direct endolymphatic sac instillation.
  
  
  METHODS
  Vertigo control, hearing results, and survey responses.
  
  
  RESULTS
  Between 2002 and 2013, 124 patients with MD underwent endolymphatic sac decompression with shunt placement. 53 patients met inclusion criteria. Groups A, B, and C had 6 patients, 20 patients, and 27 patients, respectively. Mean follow-up was 56months. Vertigo control improved in 66%, 83%, and 93% of Groups A, B, and C. Functional level improved for Group B (-2.0) and Group C (-2.2) but was unchanged in Group A. Pure-tone average and speech discrimination scores changed by +22dB and -30%, +6dB and -13%, and +6dB and -5% in Groups A, B, and C. The long-term hearing results were significantly better with steroids (Groups B and C) according to the AAO-HNS 1995 criteria but did not meet significance on non-parametric testing.
  
  
  CONCLUSIONS
  Endolymphatic sac shunt procedures may benefit from steroid instillation at the time of shunt placement.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: cameron.wick@gmail.com.
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Wick
authors.affiliation: Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Nauman F
authors.initials: NF
authors.lastname: Manzoor
authors.affiliation: Department of Internal Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Caileigh
authors.initials: C
authors.lastname: McKenna
authors.affiliation: Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Maroun T
authors.initials: MT
authors.lastname: Semaan
authors.affiliation: Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Cliff A
authors.initials: CA
authors.lastname: Megerian
mesh_terms: D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D003907:Dexamethasone / Q000008:administration & dosage*; D004712:Endolymphatic Sac / Q000601:surgery*; D004713:Endolymphatic Shunt / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006309:Hearing / Q000502:physiology*; D006801:Humans; D000069555:Injection, Intratympanic; D007322:Instillation, Drug; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone
keywords: Endolymphatic hydrops; Endolymphatic sac; Meniere's disease; Shunt; Steroid