Meniere's Disease

Endolymphatic Sac Surgery for Meniere's Disease (surgical photos below)

 

There are many options for the management of Meniere's disease that DO NOT involve surgery. This includes avoidance of salty foods/caffeine/alcohol, consuming multiple small meals during the day rather than one large serving in the evening, and diuretics (potassium-sparing like triamterene-HCTZ or acetazolamide).
 
For some patients, intratympanic gentamicin (injection of an aminoglycoside antibiotic called gentamicin into the middle ear in the office) to chemically ablate the vestibular system of the affected ear may be helpful if the patient ALREADY has a sensorineural hearing loss in the ear and recurrent or refractory symptoms of dizziness and vertigo referable to the affected ear. This can be very effective for some patients with moderate to severe hearing loss in the ear with persistent Meniere's disease symptoms (dizziness and vertigo). Gentamicin is known to be preferentially toxic to vestibular hair cells > cochlear hair cells, but some patients do lose hearing after this therapy.
 
Meniere's is also known as Secondary Endolymphatic Hydrops and/or Delayed Endolymphatic Hydrops; specifically in the case when Meniere's develops in an ear that was previously damaged from some other cause.
 
For patients who have useful hearing in an ear afflicted with Meniere's disease but are suffering from dizziness despite maximal medical management, an endolymphatic sac decompression may be a reasonable option.
 
This surgery is performed in an outpatient setting, and after a period of recovery, may help 50% of patients improve symptoms of vertigo and dizziness. The risks of hearing loss are lower than that of intratympanic gentamicin and so a endolymphatic sac decompression - shunt placement may be a better option for Meniere's patients who have useful hearing that remains in the affected ear.
 
 
Intra-operative photo of a right ear in a woman with right-sided Meniere's disease, mild hearing loss with normal word discrimination scores, and persistent symptoms of dizziness and vertigo despite a strict low salt diet and diuretics. A mastoidectomy has been performed and the sigmoid sinus has been skeletonized. The endolymphatic sac is visualized here and is found just inferior to the vestibular labyrinth. 
A #64 Beaver blade is used to incise and open the endolymphatic sac in this right ear.
 

A sheet of Silastic is placed into the opened endolymphatic sac.