Lateral semicircular canal plugging: A simple and effective surgical treatment against incapacitating Meniere's disease

摘要

Objectives: To present lateral semicircular canal plugging (LCP) technique and late results dedicated to patients with incapacitating Meniere's disease. Method: In a prospective case-controlled baseline study, patients with unilateral incapacitating Meniere's disease were treated either by LCP (n= 11) or by vestibular neurotomy (VN) (n= 11). LCP was performed by retro auricular approach, vestibular neurotomy by retro sigmoid approach. According to Meniere's disease therapeutic evaluation guidelines, disability and hearing loss were assessed before and after both surgical treatments, with a 2 years follow-up at least. After LCP, a CT and MR1 scan analyse was performed on the inner ear. Results: LCP was effective (A or B class) in 82% of cases (n= 9/11), 91% after VN (n = 10/11). When treatment was effective, 100% of patients regained a normal life after LCP (postoperative functional level 1 or 2, n= 9/9), versus 50% after VN (n= 5/10). After LCP, postoperative hearing level was unchanged in 82% of cases, n= 9/11 (73% after VN, n= 8/11), and decreased of about 30 dB in 18% (n= 2/11). There was no surgical complication. The endolymph interruption area was well visualized on MRI, allowing determining the optimal plugging area to be as far as possible from the ampulla. Conclusion: LCP is a simple and safe new treatment that could be very useful to control vertigo in Meniere's disease. Early and late tolerance are excellent. This prospective study will go on to evaluate the potential of this innovating treatment: LCP could be recommended as an alternative to VN or chemical labyrinthectomy, except in case of drop attacks.