Long-term outcomes of endolymphatic sac shunting with local steroids for Meniere's disease

Objectives To evaluate the long-term efficacy of endolymphatic sac shunt techniques with and without local steroid administration. Study design Retrospective case series and patient survey. Setting Tertiary university hospital. Patients 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. Interventions 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. Main outcome measure(s) 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 56 months. 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 + 22 dB and − 30%, + 6 dB and − 13%, and + 6 dB 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.