Delayed endolymphatic hydrops: Study and review of clinical implications and surgical treatment - Brief Article

Ear, Nose & Throat Journal, Feb, 2001 by Tsun-Sheng Huang, Ching-Chen Lin

Surgery was necessary for 67 patients, including the one with bilateral DEH. An initial transmastoid labyrinthectomy was performed on 56 patients, ELS surgery on six, and cochleosacculotomy on five. Three patients who had failed initial ELS surgery later underwent a labyrinthectomy.

Contralateral DEH. In the 54 patients with contralateral DEH, the presumed causes of hearing loss were upper respiratory tract infection with high fever in seven, otitis media and mastoiditis in five, mumps in five, head injury in five, sudden deafness in four, measles in two, acoustic trauma (by firecrackers) in one, and meningitis in one (table 2). There were 18 unknown causes that occurred during childhood and six during adulthood. At the initial visit, patients' ages ranged from 20 to 65 years (mean: 46). Their ages at the onset of hearing loss ranged from 4 to 50 years (mean: 14), and their ages at the onset of inner ear symptoms ranged from 15 to 75 years (mean: 41). The length of delay between the onset of deafness and the onset of vertigo ranged from 5 to 66 years (mean: 28).

Surgery was required for 16 of these patients. All of them had a fluctuating hearing loss in addition to their vertigo, as evidenced by a positive glycerol test as documented by serial audiography.

Results

Ipsilateral and bilateral DEH. Among the 56 patients who underwent an initial or revision transmastoid labyrinthectomy, symptoms were completely controlled in 49 (88%), including the three of the six (seven ears) who had failed ELS surgery (see case report 1) (table 3). The other seven patients experienced a relief of vertigo but not dizziness; their dizziness was brought under control with medical therapy. The patient with bilateral DEH continued to experience dizziness, which was controlled by medication (see case report 2).

A complete relief of symptoms was achieved in four of the five patients who underwent a cochleosacculotomy. The remaining patient was subsequently and successfully treated with vestibular streptomycin perfusion (see case report 3).

Including the bilateral case, a total of 68 surgical procedures were performed for ipsilateral DEH.

Contralateral DEH. All 16 patients with contralateral DEH whose vertigo was refractory to medical therapy underwent ELS surgery with various draining methods. In the seven most recent cases, the endolymphatic sac was drained and its lumen expanded by insertion of a fan-folded Silastic sheet (endolymphatic sac balloon surgery). In four patients, a device with a capillary tube (Arenberg's inner ear valve or Austin's endolymph dispersement drain) was inserted into the endolymphatic duct. Four other patients had their endolymphatic sac drained by a simple incision, and one patient underwent decompression alone.

Thirteen of the 16 patients (81%) experienced a complete resolution of vertigo following ELS surgery, while the remaining three experienced substantial control; these latter three patients reported dizziness, which was controlled medically (table 4). Hearing levels were maintained in 14 patients, improved in one (see case report 4), and worse in one (see case report 5).