Endolymphatic Subarachnoid Shunt for Ménière's Disease: Report of a Case With an Unusual Complication Following This Procedure
01 Aug 1965-Archives of Otolaryngology-head & Neck Surgery (American Medical Association)-Vol. 82, Iss: 2, pp 144-146
TL;DR: The patient was prescribed a regimen of intravenous histamine, diphenhydramine (Benadryl) hydrochloride, and a nutritional supplement (Lipoflavonoid) and continued to complain of fullness in the right ear, tinnitus, and diminished hearing.
Abstract: SINCE Aug 7, 1961, a total of 243 primary operations involving endolymphatic subarachnoid shunt have been performed. The following report of a case represents an unusual complication following this procedure. Report of Case A 54-year-old diabetic man was seen in October 1963. He presented with a two-month history of tinnitus, fullness, and fluctuating hearing loss in the right ear. He also complained of intermittent positional vertigo of many years' duration. Audiograms showed a low-tone loss in the right ear. His Short Increment Sensitivity Index (SISI) score was 0% at a frequency of 4,000. Petrous pyramid x-rays were interpreted as normal. Caloric responses were normal. The patient was prescribed a regimen of intravenous histamine, diphenhydramine (Benadryl) hydrochloride, and a nutritional supplement (Lipoflavonoid). He continued to complain of fullness in the right ear, tinnitus, and diminished hearing. Dizziness and nausea occurred almost daily. Because of his failure to respond to the
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TL;DR: This paper will review in detail what I consider to be a very promising procedure, namely, the cryosurgical treatment of Meniere's disease, which is characterized by episodic vertigo, tinnitus, and fluctuating, but progressive, loss of hearing.
Abstract: THIS PAPER represents a progress report regarding my present concepts of Meniere's disease and the surgical management of this problem. Specifically, I will review in detail what I consider to be a very promising procedure, namely, the cryosurgical treatment of Meniere's disease. Concepts of Meniere's Disease Meniere's disease is characterized by episodic vertigo, tinnitus, and fluctuating, but progressive, loss of hearing. The most distressing of these symptoms to the patient is the episodic vertigo. At present, my concepts of the inner ear as related to Meniere's disease are as follows: Meniere's Disease Results When There Is an Accumulation of Excess Endolymph Due Either to Overproduction or Underabsorption.—In 1871, Knapp 1 suggested that "glaucoma of the eye is perhaps a counterpart of Meniere's disease." Portmann2,3 concluded that the crisis of localized hypertension could be handled by decompression in a manner similar to the treatment of ocular glaucoma. Therefore, in 1927,
49 citations
TL;DR: WILLIAM House was the first to suggest inserting polyethylene film into the endolymphatic sac to protrude out over the exposed dura of the posterior fossa to enlarge the area available for the absorption of excessEndolymph in Meniere's disease.
Abstract: WILLIAM House was the first to suggest inserting polyethylene film into the endolymphatic sac to protrude out over the exposed dura of the posterior fossa to enlarge the area available for the absorption of excess endolymph in Meniere's disease. He reported "complete relief for more than two years from severe weekly attacks of vertigo in one patient, with no change in the hearing. In another patient there was a considerable improvement for three months, ear pressure and tinnitus ceased, hearing increased (with development of an air-bone gap), and he had no more attacks of vertigo, although for the previous nine years he had experienced two attacks per week. In two patients recruitment and ear pressure were markedly reduced, but tinnitus and vertigo disappeared for less than a week only. The fifth patient showed no improvement. In no case was any symptom worsened." 1 Despite these good results, and the lack
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01 Jun 1986
TL;DR: In this paper, a pilot study was undertaken to evaluate the efficacy of cochleosacculotomy for Meniere's disease in 5 patients with intractable vertigo due to idiopathic hydrops.
Abstract: A pilot study was undertaken to evaluate the efficacy of cochleosacculotomy for Meniere’s disease. The procedure was carried out on 5 patients with intractable vertigo due to idiopathic hydrops. The mean duration of follow up was 9.6 months, the longest follow up being 18 months. All 5 patients were completely free from vertigo. Hearing was unchanged (W10 dB) in 3. Tinnitus remained the same. Postoperative ENG showed significantly improved vestibular function. These results indicate that cochleosacculotomy compares favourably with other surgical procedures for Meniere’s disease.
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TL;DR: The operation of vertebral-body fusion following subtotal removal of the disk with partial laminectomy has been employed since 1943 and in the writer's experience has proven to be superior to any other operative procedure employed for relief of pain in the back and leg caused by ruptured lumbar disks.
Abstract: I N THE surgical treatment of ruptured lumbar intervertebral disks, the operation of vertebral-body fusion following subtotal removal of the disk with partial laminectomy has been employed since 1943. This operation has been performed on over 600 patients and in the writer's experience has proven to be superior to any other operative procedure employed for relief of pain in the back and leg caused by ruptured lumbar disks. The high percentage of permanent cures, the rapid rate of spinal fusion, short period of hospitalization and convalescence, and the early ability of the patient to return to heavy work are the factors upon which these conclusions were drawn.4 The poor results obtained in the treatment of disease of intervertebral disks in the cervical region, both from conservative therapy and surgical treatment, has been the concern of surgeons for many years. In an attempt to overcome some of these problems encountered with ruptured cervical disks, the methods used in the treatment of lumbar disks were considered.3 If the symptomatic lesion of the cervical disk not demonstrated by a myelogram could be identified by diskography and if the pathological joint could be treated surgically by an interbody fusion as is done for lumbar disks, the results from the treatment should be greatly improved. These criteria have been realized by an anterior approach to the cervical disk. The technical difficulties encountered in the operations currently in use to expose and remove a ruptured cervical disk and/or the osteophytes on the margins of the vertebral bodies may be one reason for the poor results obtained by surgical treatment. The obstacles are primarily anatomical. A comparison between the conventional cervical and lumbar disk operations from a technical standpoint probably explains the excellent results obtained in treating the lumbar disk compared to the poor results for the cervical lesion. The surgical approach to the lumbar disks through the spinal canal is facilitated by the retractability of the long lumbar nerve roots and the dural sac which contains only the cauda equina and cerebrospinal fluid. This approach for performing lumbar vertebral-body fusion is greatly facilitated by use of special self-retaining retractors designed for this operation. With these instruments both the spinal canal and the intervertebral space are
1,672 citations
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25 Jul 1990
TL;DR: This book discusses surgery of the Ear, diagnosis of Ear Disease, and surgical Anatomy of the Temporal Bone Through Dissection.
Abstract: Part 1 Introduction to Surgery of the Ear: Development Anatomy of the Ear: Surgical Anatomy of the Temporal Bone: Diagnosis of Ear Disease: Conventional Radiologic Examination of the Temporal Bone: Neuroradiologic Examination: Principles of Temporal Bone Surgery. Part 2 Surgery of Infections of the Ear: Pathology and Clinical Course of Inflammatory Disease of the Middle Ear: Operations of the Auricle, External Meatus and Tympanic Membrane: The Simple Mastoid Operation: the Open Cavity Mastoid Operations: Intracranial Complications of Otitis Media: Aural Complications of Otitis Media: Mechanics of Hearing: Surgical Correction of Congenital Malfformations of the Sound-Conducting Mechanism: Closure of Tympanic Meembrane Perforations: Tymparoplasty: Diagnosis, Indications for Saurgery and Medical Therapy of Otospongiosis (Otosclerosis): Stapes Operations for Otospongiosis (Otosclerosis). Part 3 Surgery of the Facial Nerve, Endolymphatic Hydrops and Tumours of the Ear: Facial Nerve Surgery: Surgical Treatment of Peripheral Vestibular Disorders: Skull Base Surgery: Acoustic Neuroma and Tumours of the Cerbellopontine Angle: Implantable Hearing Devices: Surgical Anatomy of the Temporal Bone Through Dissection.
473 citations
TL;DR: Excessive endolymphatic pressure, established as a feature of Ménière's disease by recent experiments and probably due to disturbed absorption, may be corrected by drainage of the endolyphatic sac by using the operating microscope, diamond dental drill and continuous irrigation.
Abstract: Excessive endolymphatic pressure, established as a feature of Meniere's disease by recent experiments and probably due to disturbed absorption, may be corrected by drainage of the endolymphatic sac. By use of the operating microscope, diamond dental drill and continuous irrigation, the endolymphatic sac can be accurately identified and opened under direct vision. Continuous drainage of endolymph is maintained by creating a shunt into the subarachnoid space through a silicone rubber tube inserted into the sac.
Seven patients, observed for two to six months, showed relief of most symptoms of Meniere's disease, with improvement of hearing in the majority. Although a larger series of patients and a longer follow-up period will be required for conclusive evaluation, these early results indicate that continuous drainage of endolymph is an effective treatment of Meniere's disease.
109 citations