ENDOLYMPHATIC SAC DECOMPRESSION AND SHUNT INSERTION

This operation is performed in patients with Meniere’s disease who suffer from unrelenting vertigo despite maximal medical therapy. It is primarily done to stop or decrease the severity of the vertigo attacks. It is occasionally performed to stop a fluctuating hearing loss from progressively declining. It is the only surgery that has the potential to reverse what is going awry in the ear, but maintain the residual balance and hearing at pre-operative levels. Other surgical procedures for Meniere’s disease are “ablative”, meaning they remove the balance function from the ear.
The procedure is done on an outpatient basis in the hospital or surgery center under general anesthesia. It takes 1-1.5 hours.

An incision is performed behind the ear and the mastoid bone is opened. The bone over the endolymphatic sac is then completely removed. A laser is used to make an incision into the outer layer of the sac, and a piece of silastic sheeting or tubing is inserted into the sac. The incision is closed and the person is brought to the recovery room and goes home about an hour after waking up.

Post-op Care

Antibiotics are taken for a week to prevent infection. There is little pain and most people use over the counter medications for the pain. Vicodin is occasionally used. The patient can return to work the following day. The hearing is clogged for a few weeks and then gradually returns to normal.

Possible Complications

• Lack of benefit: The biggest risk is that the surgery may not be effective .
• Vertigo: Vertigo attacks may be unchanged in severity or frequency. 10-25% of patients may feel they have not benefited from the surgery. Vertigo is seldom worsened by the surgery.
• Hearing Loss: About 25% of patients will have improved, or more stable hearing. Hearing loss can occasionally be worse after surgery.
• Tinnitus: This is usually unchanged by the surgery. It can occasionally worsen, but this is rare. Some patients can hear their heartbeat in the ear after surgery.
• Facial Nerve Injury: This can occur after any ear surgery. It is extremely rare. Special equipment is used to identify and monitor the nerve during surgery.
• Spinal fluid leak: This is extremely rare but can lead to meningitis.