ENDOLYMPHATIC HYDROPS Meniere’s disease...Failure of this function results in endolymphatic...
Transcript of ENDOLYMPHATIC HYDROPS Meniere’s disease...Failure of this function results in endolymphatic...
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ENDOLYMPHATIC HYDROPS Meniere’s disease
© Bruce Black MD
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Normal inner ear physiology. Endolymph generated in the inner ear drains via the saccus endolymphaticus (SE).
Failure of this function results in endolymphatic hydrops (Meniere’s Disease, ELH). © Bruce Black MD
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ELH: Failure of the saccus drainage results in four outcomes: fullness in the ear, tinnitus, a (usually low
frequency) sensorineural deafness and rotatory vertigo. The exact cause of failure remains undecided. © Bruce Black MD
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Audiology in ELH. Initially, the low frequency SND may fluctuate, worse during episodes, then recovering. Pre-
existent high frequency losses may produce a flat pattern on the affected side. © Bruce Black MD
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Audiology in early ELH. The hearing loss may antedate vertigo by several years, or the problem may progress
rapidly, perhaps severely. © Bruce Black MD
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Rigorous restriction of salt intake appears beneficial in many ELH cases, but the mechanism remains unclear.
© Bruce Black MD
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Intra-tympanic perfusions of gentamicin effectively minimise vertigo in most cases of ELH, avoiding surgery, but do not
restore hearing and are ineffective for tinnitus. © Bruce Black MD
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Saccus surgery, surgical landmarks. Lateral sinus-jugular bulb, VII (anterolateral) and semi-circular canals. © Bruce Black MD
Illustration by courtesy Robt Jackler MD
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Saccus decompression/drainage, effective in many cases. Mastoidectomy exposure (above) may be enhanced by
lateral sinus compression (below). © Bruce Black MD
Illustration by courtesy Robt Jackler MD
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Saccus surgery: “Egg-shelling” the overlying bone. © Bruce Black MD
Illustration by courtesy Robt Jackler MD
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Site of the saccus. This is variable in size, direction and visibility. In some cases only a mass of tubules is present.
© Bruce Black MD
Illustration by courtesy Robt Jackler MD
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Saccus incision and insertion of a Silastic strip to promote drainage. The efficacy of this step remains to be confirmed
in the literature. © Bruce Black MD
Illustration by courtesy Robt Jackler MD
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Saccus (S) exposure (left ear), bounded by the sinus (below left, S), and the semicircular canals ( above, right
LC, PC). The VII is not seen in this view. © Bruce Black MD
LS
PC
LC
S
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Detail of the previous view. Saccus indicated.The VII lies in the shadowed area above.
© Bruce Black MD
VII
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Trans-mastoid labyrinthectomy, left ear, showing the lateral semicircular canal (LC). The vessels of the posterior genu
of the VII are seen within bone on the left (arrowed). © Bruce Black MD
LC
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Exenteration of the SCCs, initial LSCC canal clearance with a 2 mm diamond drill, avoiding the genu to the left.
© Bruce Black MD
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Detail of the initial exposure of the lumen of the LSCC. Note the proximity of the genu vessels on the left. The posterior
geniculate artery in the latter is a valuable surgical landmark. © Bruce Black MD
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Advancing canal clearance. The lateral canal is partially removed and the superior canal is substantially displayed.
© Bruce Black MD
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Demonstration of the extent of the superior canal. The lateral canal has been totally cleared, avoiding the adjacent
VII. © Bruce Black MD
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Subtotal clearance of the SSCC, with the posterior canal partially visible posteriorly.
© Bruce Black MD
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Advancing bone clearance, with entry into the vestibule above and below.
© Bruce Black MD
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Labyrinthectomy, nearing completion as the vestibule is exposed. Total canal clearance. Note the proximity of the
VII on the left. © Bruce Black MD
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Axial CT, post-labyrinthectomy, left ear showing the residual and aerated mastoidectomy site.
© Bruce Black MD
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Relationship of the (Lt) VIII, IAC and inner ear. The vestibular VIII may be selectively sectioned to eliminate
vertigo in ELH, whilst sparing the hearing. © Bruce Black MD
Illustration by courtesy Robt Jackler MD