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ENDOLYMPHATIC SAC ENHANCEMENT

In Meniere’s disease and excessive amount of endolymph (inner ear fluid) is present in the fluid-filled channels of the inner ear. As the volume of fluid increases, hearing loss and vertigo (dizziness) usually result.  Although this disease is not life threatening, in some cases the vertigo can be incapacitating and often deafness of the affected ear eventually occurs. Patients usually experience a triad of symptoms, including loss of hearing, episodic vertigo or dizziness, and tinnitus (buzzing or ringing in the ear). Many patients also experience a feeling of fullness or pressure in the ear and intolerance for loud noises.

Although a cure for Meniere’s disease is not available to date, a surgical procedure called endolymphatic sac enhancement can be performed to enhance absorption of endolymph.  This procedure provides an approximately 90% chance of less frequent and/or less intense episodes of vertigo and approximately 75% chance of elimination of vertigo.  There is approximately a 40% chance that the hearing will improve and 98% chance that hearing will be preserved.  A post auricular (behind the ear) incision is made.  An opening is made through the mastoid bone in order to expose the endolymphatic sac in the dura. Special techniques are used to enhance improved absorption of the fluid.

Endolymphatic sac enhancement carries certain risks due to location of the sac and its spatial relationship to the brain and to certain nerves.  The facial nerve crosses through the mastoid bone. This nerve could be bruised or postoperative swelling could compress it and cause weakness on that side of the face.  When this occurs, which is extremely rare, the weakness is almost always temporary. Occasionally leakage of cerebrospinal fluid (fluid which surrounds the brain and spinal cord) may occur initially after surgery. Usually within one or two days the opening will close on its own and the patient suffers no ill effects.

It is possible that there may be a period of unsteadiness following surgery. Most patients are up and about and are discharged from the hospital on the day following surgery.  As with any surgery, post-surgical infection is a possibility. However, antibiotics are given routinely during and after surgery so that infection is rarely a problem.  Though there is an approximately 2% chance of postoperative hearing loss, deafness can occur without surgery. We are fortunate, with modern technology, to have developed this very delicate operation which is a success in most cases in spite of the rare complications, which may arise.   

 
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