Abstract
To enhance the treatment effects for intractable Meniere's disease, we tried to expose the opened endolymphatic sac to high concentrations of steroids. This technique - endolymphatic sac drainage and steroid-instillation surgery (EDSS) - involves the application of a mass of prednisolone followed by absorbable gelatin sponges soaked in a high concentration of dexamethasone into the sac lumen opened and expanded with a bundle of absorbable gelatin films. These sponges are also placed around the sac and coated with biochemical adhesive so that the medicine is slowly delivered into the sac over a prolonged period of time as a natural sustained-release vehicle. EDSS was performed for 50 patients with intractable Meniere's disease by the first author (Tadashi Kitahara) at Osaka Rosai Hospital from 1998 to 2001. The long-term results (AAO-HNS criteria in 1995) in 50 patients treated by this technique showed that definitive spells were completely controlled in 80% out of the 50 cases. Hearing was improved by more than 10 dB in 50% out of the 50 cases. Mechanisms of EDSS effects on the labyrinthine functions are thought to be multiple steroid effects: anti-inflammatory, anti-edematic and vasoactive effects. Steroids directly instilled into the endolymphatic cavity may be more effective on the diseased inner ear organs than those applied via any other route.
