RESUMEN
This study, merging data from two different clinics, was undertaken to evaluate the efficacy of endolymphatic mastoid shunt surgery using the Denver Inner Ear Shunt operation for Meniere's disease. This surgery was performed by the senior authors (C.G.J., J.R.E.D., and M.E.G.) between May 1984 and October 1986, after we attended the Colorado Otologic Research Center (CORC) instructional course. Sixty-six and thirty-four cases, respectively, were performed. Follow-up questionnaires were sent to this total of 100 patients. Fifty-six patients returned completed questionnaires, which formed the basis of this report. A retrospective chart study was also carried out. The results of surgery and questionnaires are reported as statistical data, and, where applicable, the 1985 AAO-HNS criteria for reporting vertigo and hearing results in the treatment of Meniere's disease are used. Preliminary analysis of these data is reported because of its profound effect upon our treatment protocol for patients with Meniere's disease. Results on use of the Denver valve do not appear to be significantly different than the results of other shunt surgery not using the valve.
Asunto(s)
Anastomosis Endolinfática/métodos , Adolescente , Adulto , Anciano , Audiometría de Tonos Puros , Comportamiento del Consumidor , Femenino , Humanos , Masculino , Enfermedad de Meniere/fisiopatología , Enfermedad de Meniere/cirugía , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Pruebas de Discriminación del HablaRESUMEN
The present study was designed to examine the effects of cochleostomy on the development of endolymphatic hydrops in the rabbit. Fistulization of the cochlear partition and simultaneous obstruction of the endolymphatic duct was performed in one group of animals (n = 13). Rabbits in two other groups underwent either cochleostomy (n = 6) or endolymphatic duct obstruction (n = 6) alone. Animals were terminated at 1-, 4-, and 6-week intervals and the cochleas were examined with the light microscope to document the presence or absence of hydrops, or were evaluated with the scanning electron microscope to assess sensory-cell damage. Hydrops was observed in 67% of the animals in the combined duct-obstruction/cochleostomy group, in 100% of the duct-obstruction alone group, and in 0% of the cochleostomy alone group. Widespread sensory-cell degeneration was observed with the scanning electron microscope in the combined and the cochleostomy alone groups.
Asunto(s)
Cóclea/cirugía , Edema/fisiopatología , Endolinfa/fisiología , Líquidos Laberínticos/fisiología , Animales , Conducto Endolinfático/fisiopatología , Células Ciliadas Auditivas/ultraestructura , Microscopía Electrónica de Rastreo , Órgano Espiral/ultraestructura , ConejosRESUMEN
Fistulization of the membranous labyrinth via a surgically created endolymphatic-perilymphatic shunt (cochleosacculotomy) is currently being advocated as a treatment for endolymphatic hydrops. As a preliminary study to the investigation of the effects of labyrinthine fistulization on the hydropic condition, we sought first to reproduce the cochleosacculotomy procedure in a series of normal animals. Fistulization of the cochlear duct was performed in 15 normal animals using a tungsten wire directed via the round window through the cochlear partition in the region of the organ of Corti. The animals were sacrificed at regular intervals and the cochleas examined for histopathologic changes with the scanning electron microscope. Observations suggest that discrete permanent fistulization of the cochlear duct in the normal guinea pig results in progressive sensory cell degeneration. The implication of these observations and the apparent difference between these results and the experience thus far reported in humans are discussed.