Die Saccotomie in der Behandlung des M. Ménière: Beurteilung der kurz-, mittel- und langfristigen Ergebnisse anhand eines Patientenfragebogens

Zusammenfassung

Einleitung: Die operative Drainage des Saccus endolymphaticus zur Behandlung des M. Ménière wurde bereits in den 1920er Jahren beschrieben. Sie führt bei 50–80% der Patienten zur Symptomenkontrolle. Dennoch ist diese operative Technik stets kontrovers diskutiert worden. Auch ist die für eine erfolgreiche Operation nötige intraoperative Identifizierung des Saccus endolymphaticus mitunter nicht einfach. Ziel dieser Studie war es daher, die kurz-, mittel- und langfristigen Ergebnisse in einem größeren Patientenkollektiv zu untersuchen.

Material und Methoden: In einer retrospektiven Studie mit 74 Patienten wurden anhand eines Patientenfragebogens die Schwindelbeschwerden, die Ohrgeräusche und die Zufriedenheit evaluiert. Zusätzlich wurde in einer Untergruppe die diagnostische Bedeutung der Elektrocochleografie (EcochG) untersucht.

Ergebnisse: Eine Kontrolle der Schwindelbeschwerden wurde in der Gruppe bis 2 Jahre postoperativ bei mehr als 70% der Patienten erreicht. In der Gruppe, deren Eingriff mehr als 2 Jahre zurücklag, betrug dieser Wert 81%. Tinnitusbeschwerden verschwanden bei 11% und besserten sich bei 23% der Patienten. Bei 47% der Patienten in der untersuchten Gruppe blieb der Tinnitus gleich, bei 19% verschlechterte er sich. Der Unterschied zwischen prä- und postoperativen Ergebnissen in der EcochG war statistisch hoch signifikant.

Schlussfolgerung: Die Saccotomie ist auch weiterhin als ein nützliches Instrument zur Symptomenkontrolle des M. Ménière anzusehen, insbesondere bei Patienten, die mit konservativen Maßnahmen keine ausreichende Besserung erfahren.

Short and Long Term Results of Endolymphatic Sac Surgery: A Patient-Questionnaire Based Study

Introduction: The endolymphatic sac surgery for the treatment of Meniere's disease has been described since the 1920s. The success rate of this technique in terms of vertigo control has been reported to be 50–80%. However, the value of this treatment method remained controversial. Furthermore, the reliable identification of the endolymphatic sac intraoperatively can be challenging in some cases. This study examines the short-, middle- and long-term results in a larger cohort of patients.

Materials and methods: In 74 patients, vertigo control, tinnitus and degree of satisfaction was evaluated by means of a questionnaire retrospectively. Additionally, the diagnostic value of the electrocochleography (EcochG) was determined.

Results: The overall vertigo control rate was more than 70% in patients followed up for two years and has reached 81% in patients followed up for more than two years. Hearing preservation rate was 61%. Tinnitus has disappeared in 11% and improved in 23% of the patients. In 47% of the patients it was unchanged and in 19% worsened. The difference in EcochG results pre- versus postoperative was highly significant.

Conclusions: ELSS is a useful tool in the management of Ménière's disease, in particular in patients that do not benefit sufficiently from conservative therapy.

Schlüsselwörter

M. Mäniäre - Saccotomie - Elektrocochleografie

Key words

Mäniäre disease - endolymphatic sac surgery - Electrocochleography

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