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Contributors: Amelia Cussans and Mr Shreeshyla Basavaraj
Music: Fifth Avenue Stroll
Ménière’s disease is an inner ear disorder, characterised by intermittent attacks of vertigo, fluctuating hearing loss, tinnitus and sense of pressure in the ear. The pathophysiology is not fully understood; however, it is believed to be associated with abnormal fluid regulation of the endolymph. Whilst medical therapy is sufficient in most cases, some patients require surgical intervention. Endolymphatic sac decompression is one of the surgical methods that can be employed in the treatment of patients with medically intractable Ménière’s disease. It aims to reduce vertigo by relieving endolymphatic pressure in the cochlea and vestibular system. This video demonstrates Mr Sreeshyla Basavaraj’s surgical technique.
Cortical mastoidectomy is performed, exposing the lateral semi-circular canal. The lateral semi-circular canal and posterior canal is delineated with a size 2-3mm cutting bur. Drill out all the bone between the posterior semi-circular canal and posterior fossa dura, to expose the sac and duct. This is done using a size 1 or 1.5mm cutting bur. Good exposure above and below the endo-lymphatic sac and duct prevents recurrence of disease. The thin bone on the posterior fossa dura, and endo-lymphatic sac and duct is removed using a small curette. Using a sickle knife, the duct and sac is delineated from the surrounding structure. Once the endo-lymphatic duct and sac are identified all the way from the posterior canal to the dura, it is incised with a sickle knife. The endo-lymphatic sac and duct is incised and opened to decompress the sac. Once the sac is wide open, all the bone around the endo-lymphatic sac is removed. The wound is closed in two layers using 4-0 vicryl and 4-0 prolone for skin incision. A mastoid bandage is applied for a few hours.
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Patients who do not fulfil the diagnostic criteria of âdefiniteâ Meniereâs disease should not be considered for this surgery
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