Outcomes of Endolymphatic Mastoid Shunt for Meniere’s Disease: The House Clinic Experience

Introduction: Endolymphatic Mastoid Shunt (EMS) is a non-destructive surgical option for patients with Meniere’s Disease (MD) refractory to medical treatment. However, reported outcomes vary and predictors of success are not well defined. This study evaluates postoperative outcomes following EMS at a high volume center.

Methods: Retrospective chart review of all patients with MD who underwent EMS (primary or revision) at tertiary referral center from 2013-2022. The primary outcome was self-reported post-operative dizziness, categorized as none, minimal, moderate, or severe. Pre-operative symptoms, pre-and post operative treatments, surgical complications, and audiometric outcomes were also evaluated. Descriptive statistical analysis was performed.

Results: Among our 2,322 MD patients, 142 (6.1%) underwent EMS. Follow-up ranged from 1 to 108 months (mean 39.5 ± 28.8 months). Post-operatively, 22% reported no dizziness, 37% minimal, 18% moderate, and 23% severe dizziness. When comparing patients with severe dizziness after surgery to the remainder of the cohort, there were no significant differences amongst the two groups for gender, race, or side of ear operated on. When compared to younger patients, those older than 75 did significantly worse, with a 50% failure rate after surgery (p = 0.049). Additionally, when evaluating differences amongst pre-operative treatments in the two groups, those with successful control of dizziness after EMS were more likely to have received and failed intratympanic (IT) dexamethasone treatments prior to surgery, with a 16.3% failure rate in the IT group vs 32.35% failure rate in the non-IT group (p = 0.025). Hearing outcomes were largely stable, with 125 patients (88%) having no change in their hearing status. No major surgical complications were seen.

Conclusions: EMS provided dizziness control for a meaningful subset of patients with MD. With its low morbidity profile, EMS remains a reasonable option prior to destructive interventions. However, given the above findings, patient age and prior failure of IT steroid injection should be taken into consideration.