Endolymphatic Shunt Surgery Comparable to Intratympanic Gentamicin in Controlling Vertigo in Ménière’s Disease

How does endolymphatic shunt surgery (ESS) compare with intratympanic gentamicin injections (ITG) in terms of audiovestibular outcome in patients with Ménière’s disease (MD)?

Bottom line: ESS provides successful vertigo control at least as well as ITG, with a lower incidence of audiovestibular complications.

BACKGROUND: Approximately 15% of patients with MD are not significantly helped by lifestyle and dietary changes alone. For these patients, ESS, a nondestructive surgical treatment, or its nonsurgical alternative, ITG, is widely used. Studies have shown various differences in results from the two options, but not specifically how they compare regarding vertigo control.

STUDY DESIGN: Retrospective matched cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle.

SYNOPSIS: Researchers conducted a retrospective chart review of evaluated outcomes for 44 patients who had undergone ESS and 27 patients who had been treated with ITG at a single facility between 2004 and 2017. Successful control of vertigo was considered a symptom reduction of 60%–100%. Pure-tone average (PTA) and word recognition score (WRS) taken pre- and six months posttreatment were compared. In the ESS group, 72.7% of patients had subjective improvement in vertigo symptoms, and 40.9% experienced hearing deterioration. In the ITG group, 63.0% of patients had subjective improvement in vertigo symptoms, and 52.0% experienced hearing deterioration. Chronic unsteadiness appeared in 29.6% of the ITG group but did not appear in the ESS group. There was no significant difference in PTA changes between groups, but the WRS change favored the ESS group. Overall, ESS provided vertigo control at least as well as ITG, with potentially better auditory outcomes and without the chronic unsteadiness found in the ITG group. The risk of measurement bias was a limitation of the study.

CITATION: Gibson AW, Moon IJ, Golub JS, et al. A comparison of endolymphatic shunt surgery and intratympanic gentamicin for Ménière’s disease. Laryngoscope. 2020;130:2455-2460.