An endolymphatic shunt is a surgical procedure in which a very small silicone tube is placed in the membranous labyrinth of the inner ear to drain excess fluid.
An endolymphatic shunt is placed as part of the treatment of Ménière's disease, a disorder of the inner ear whose causes are still unknown. Ménière's disease is characterized by the following symptoms:
Endolymphatic shunt surgery is one of the surgical procedures available to treat Ménière's disease, which is also known as endolymphatic hydrops. The surgery is based on the theory that the disorder causes the inner ear to become overloaded with fluid and that draining this fluid will relieve the symptoms. The fluid is drained by opening the endolymphatic sac, a pouch located next to the mastoid bone at the end of the endolymphatic duct. The endolymphatic duct is a canal that leads to the inner ear.
According to the National Institute on Deafness and Other Communication Disorders (NIDCD), there were an estimated three to five million cases of Ménière's disease in the United States in 1998, with nearly 100,000 new cases diagnosed annually. In most cases only one ear is affected, but as many as 15–40% of patients are affected in both ears. The onset of Ménière's disease occurs most often in adults between the ages of 20 and 50. Men and women are affected in equal numbers.
An endolymphatic shunt is placed with the patient under general anesthesia. The operation takes about two hours to perform. The patient is usually positioned lying on the back with the head turned to one side and the affected ear lying uppermost. The head is immobilized and supported with a pad or brace. The operation itself begins with opening the mastoid bone and identifying the endolymphatic sac. To find the sac, the surgeon removes the bony cover of the sigmoid sinus, which is an S-shaped cavity behind the mastoid bone. The surgeon leaves intact a small rectangle of thin bone called Bill's Island (named for Dr. William House). The sigmoid sinus is then collapsed with gentle pressure. The surgeon exposes the endolymphatic sac and makes an incision in it in order to insert the shunt.
The diagnosis of Ménière's disease is based on the patient's medical history, a physical examination , and the results of hearing tests, balance tests, an electronystagmogram, and imaging studies. An MRI or CT scan is performed to rule out a tumor as the cause of the patient's symptoms. A hearing test (audiogram) identifies the hearing loss that is typical of Ménière's disease. Balance function tests are administered to assess the patient's vertigo.
The patient is prepared for surgery by having the hair removed and the skin shaved over an area of at least 1.5 in (3.8 cm) around the site of the incision. A mild solution of soap and water is commonly used to cleanse the outer ear and surrounding skin.
The operated ear is covered with a Glassock dressing, which is a special dressing applied to keep pressure on the site to reduce swelling. There is usually some tenderness and discomfort in the operated ear and the throat (from the breathing tube inserted during surgery), which can be controlled by such analgesic medications as meperidine (Demerol) or oxycodone (Percocet).
There are few risks associated with endolymphatic shunt surgery. The operation is considered the first-line surgical treatment for Ménière's disease precisely because it is very safe. The chance of hearing loss from the procedure is about 0.5%.
Endolymphatic shunt surgery relieves the vertigo associated with Ménière's disease, with restoration of hearing dependent on the severity of the disease. The patient's ear may protrude slightly shortly after surgery but usually returns to its original position within two to three weeks after the operation. Numbness around the ear is a common complication that may last for several months.
Endolymphatic shunt surgery is considered a lowmorbidity procedure. It has been reported to achieve complete or substantial control of vertigo in 81% of patients, with significant improvement in hearing in about 20%. Overall, there is a 60% chance of curing the vertigo, a 20% chance that the attacks will remain at the same level of severity, and a 20% chance that the attacks will get worse. The patient's vertigo usually improves even if hearing does not improve.
There are several nonsurgical treatments recommended for patients with Ménière's disease:
Surgical alternatives to the placement of an endolymphatic shunt include:
Graham, M. D. Treatment Options for Ménière's Disease: Endolymphatic Sac Surgery: Do It or Don't Do It and Why? San Diego: Singular Publishing, 1998.
Haybach, P. J., and J. Underwood. Ménière's Disease: What You Need to Know . Portland, OR: Vestibular Disorders Association, 1998.
"Ménière's Disease." In The Merck Manual of Diagnosis and Therapy , edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
Brookler, K. H. "A Patient with Endolymphatic Hydrops Refractory to Shunt Surgery." Ear Nose Throat Journal 79 (July 2000): 493.
Goksu, N., Y. A. Bayazit, A. Abdulhalik, and Y. K. Kemaloglu. "Vestibular Neurectomy with Simultaneous Endolymphatic Subarachnoid Shunt." European Archives of Otorhinolaryngology 259 (May 2002): 243-246.
Mason, T. P. "What is Ménière's Disease, and How is it Treated?" Health News 9 (April 2003): 12.
Ostrowski, V. B., and J. M. Kartush. " Endolymphatic Sac-Vein Decompression for Intractable Ménière's Disease: Long Term Treatment Results." Otolaryngology Head and Neck Surgery 128 (April 2003): 550-559.
Welling, D. B., and H. N. Nagaraja. "Endolymphatic Mastoid Shunt: a Reevaluation of Efficacy." Otolaryngology Head and Neck Surgery 122 (March 2000): 340-345.
American Academy of Otolaryngology—Head and Neck Surgery. One Prince Street, Alexandria, VA 22314. (703) 806-4444. http://www.entnet.org .
National Institute on Deafness and Other Communication Disorders (NIDCD). 31 Center Drive, MSC 2320, Bethesda, MD 20892-2320. (800) 241-1044. http://www.nidcd.nih.gov/ .
Vestibular Disorders Association (VEDA). PO Box 4467, Portland, OR 97208-4467. (800) 837-8428. http://www.vestibular.org .
"Ménière's Disease–Surgical Therapy." UPennHealth. http://www.uphs.upenn.edu/balance/patient%20education%20brochures/Meniere's-Surgical%20Treatment.htm .
Monique Laberge, PhD
An endolymphatic shunt is performed in a hospital or ambulatory surgery center on an outpatient basis. It is done by an otolaryngologist, who is a surgeon specializing in disorders of the ear, nose, and throat.
I have a suggestion for an additional question to add to "Questions to ask the Doctor"; how long can a patient expect to enjoy the benefits of this procedure?
I am asking this because I don't know what either the answer or the estimate might be. In my case I had and Endolymphatic Sac Decompression performed (Graduate, Phila) in 1997, and in 2003 the symptoms returned in one complete and exacerbated instant.
My suspicion is that this happened because of an acute diuretic exchange in my body while I slept - although I was waking when I felt the onset of fullness and hyperamplified tinnitus. I also believe that the shunt is clogged or entirely displaced. I would welcome any comments about my own guess-work. I have a follow-up appointment scheduled (this after giving up on clincal mitigation the problem over 18 months ago). I intend to ask for an MRI on both my affected ear and on my good ear to compare the size of the Sac (albeit the affected ear has already been altered by the existing shunt). After reading this article I think that my own issue is a maintenance problem more than a degradation of the ear itself...?
Again, any comments would be welcomed.
Has this happened to anyone else out there?
Please God, no more vertigo...
or sing. Small problem I know compared to the bad vertigo attacks I use to have.
Will this fullness and echoing go away?
http://www.thebrainhealth.com/what-is-vertigo.html
I have also begun having pain and pressure in my right eye. The Dr says this would not be related to Menier's disease. My eye doctor checked my field of vision and said it was limited, but the neuro-ophthalmologist says my field of vision is fine. He has given me neuroton to deal with the pain, but the pressure remains. Has anyone else had similar issues?
My wife read somewhere that people can have throat problems after the shunt surgery. Is this a risk and what kind of potential problems can occur? I have just regained my voice after sever GERD and finally had surgery last year for it. My speaking voice has returned, but still does not have good duration or stamina, so I am hoping this surgery will not set me back. Unfortunately I am still not able to sing, which is a great frustration.
As far as I can tell, after over 30 years since surgery the shunt is still working. I do suffer from bi-lateral severe-classicMeniere's Disease. I had all three main symptoms to a major degree. I was diagnosed in 1977, with suggestion that the disease may have started in my early childhood.
Because vertigo is so immediately debilitating, the long term effects of repeated attacks sometimes go unnoticed for quite a while. The fear of having a serious attack, of being incapacitated abruptly, without warning, can cause lifestyle changes that shrink one's world significantly. If you suffer from Meniere's induced vertigo, I encourage you to consider the shunt surgery. While I have had a revision surgery, the time free of the vertigo was wonderful and I remain hopeful that the second surgery is and will remain successful. I feel fortunate to have viable treatment from Dr. John House, a dedicated, skilled and talented doctor.
Best of luck!
Will I regain my hearing if I have this surgery?
menieres.org/forum/index.php
Thank you!
Like many of you, the attacks have become severe and disabling. I'm not able to work and had to stop driving as I'm having attacks driving. I hate this disease, I hate feeling like I have no control. I have recently had the steroid shot in my ear, and did not receive any results from it. In fact, I never complain from any shots but this was different. Apparently, when they put something in your ear it drains to your throat. The shot went into my ear and into my throat. The pain was unbearable. It felt like strep throat of my ear and throat at same time.
I went to Dr yesterday and he told me since it didn't work that he recommended the Endolymphatic sac surgery. the hospital said that Dr didn't have any openings until June 18th. But at last minute they found one this Friday. Gives me the rest of today to not try and stress about it. To be honest it scares me to death.
I guess I'm writing this for myself not sure if anyone will read it. If you do and you are suffering with the disease to I wish you nothing but the best.
Thank you
Facebook: Gale Tierney Pheobe-Rose
Hotmail/Email: gale_tierney17@hotmail.com
Mobile number: 0422 591 981
I am afraid I do not have any other source of contact method apart from the ones above that I have mentioned for you all.
Kind Regards
Gale Tierney
asked my ENT and other doctors to take it out but since it has been in so long they will not. Now I can not get an MRI because
I can not find out what material the shunt is made of. I need to make sure it is not metal but I have no written material from the
doctor that put it in that states it is not metal. I really need the MRI but can not find out where to look for the type of material this
shunt might be made of. What a fine mess I'm in and still in pain after all these years. I have lost over half of my hearing in my
right ear and now in my left ear. And the tinnitus is taking it tow on my nerves. I think I have taken every known herbal remedy
known to man and tried sound machines to no avail. I would just like to go back to the day prior to the surgery and start over
and maybe take another look at my choices. I don't think I would have chosen the shunt. As for the tinnitus, I have also used
botox as silly as that sounds and it didn't work for those of you suffering from tinnitus, just to let you know. So, if anyone on this
site should know the material of the shunt the doctors use, please let me know. I really need to have this MRI performed.
I just want the Vertigo to be over so I can live a normal life. We dont make plans to go anywhere or travel to far because we never know how things are going to be from day to day. Vertigo Sucks. I sure hope this Surgery is a Success.
Would like to know how painful is it and how long recovery is.
the surgery what their recovery was like. I have read that this is normal, and since my first surgery was 25 years ago, I cannot remember if I had these symptoms then. Please let me hear from anyone about your post surgical experience. I am so discouraged. Thank you.
my neorotologist suggest endolympatic sac decompression . My vertigo and ringing comes from Ménière’s and not From my small benign tumor ( 0.5cm) . ( VNG test showed confirmed this as well...)
Anybody similar? Thank you so much.
I am the point that can’t work and live regularly -