Treatment of Endolymphatic Sac Surgery

Introduction

Endolymphatic Sac Surgery is a specialized surgical procedure primarily used to treat Ménière’s disease, a chronic inner ear disorder that affects balance and hearing. Patients suffering from recurrent vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear often find relief through this procedure when conservative treatments fail. This blog explains the treatment approach, procedure, benefits, risks, and recovery in detail.

Understanding Ménière’s Disease

Ménière’s disease occurs due to abnormal fluid buildup (endolymph) in the inner ear. This excess fluid increases pressure, leading to episodes of vertigo, fluctuating hearing loss, ringing in the ears, and balance disturbances. While medications and lifestyle changes help in early stages, advanced cases may require surgical intervention such as Endolymphatic Sac Surgery.

What Is Endolymphatic Sac Surgery?

Endolymphatic Sac Surgery is a hearing-preserving surgical treatment aimed at reducing inner ear fluid pressure. The procedure involves decompressing or draining the endolymphatic sac to restore normal fluid balance. Unlike destructive inner ear surgeries, this technique helps control vertigo while protecting residual hearing.

Who Needs Endolymphatic Sac Surgery?

This surgery is recommended for patients who

1. Experience frequent and severe vertigo attacks
2. Do not respond to medications, diet changes, or vestibular therapy
3. Have usable hearing that must be preserved
4. Have confirmed Ménière’s disease through diagnostic tests

An ENT specialist or neurotologist evaluates the patient thoroughly before recommending surgery.

Pre-Surgical Evaluation and Preparation

Before the procedure, patients undergo

1. Audiometry (hearing tests)
2. Vestibular function tests
3. MRI or CT scans to rule out other conditions
4. Medical evaluation for anesthesia fitness

Patients are advised to avoid blood-thinning medications and follow fasting instructions prior to surgery.

How Is Endolymphatic Sac Surgery Performed?

The surgery is usually performed under general anesthesia and takes about 2–3 hours.

Step-by-Step Procedure

1. A small incision is made behind the ear
2. The mastoid bone is carefully accessed
3. The endolymphatic sac is identified
4. The sac is decompressed or a shunt is placed to drain excess fluid
5. The incision is closed with sutures

The procedure does not involve removal of inner ear structures, making it a conservative and safer option.

Types of Endolymphatic Sac Procedures

There are different techniques used depending on the patient’s condition

• Endolymphatic sac decompression
• Endolymphatic sac drainage
• Shunt placement with silicone tubing

Your surgeon chooses the best approach based on symptom severity and anatomy.

Benefits of Endolymphatic Sac Surgery

This surgery offers multiple advantages

1. Significant reduction in vertigo episodes
2. Preservation of hearing in most patients
3. Improved balance and quality of life
4. Minimal damage to inner ear structures
5. Lower risk compared to destructive procedures

Studies show vertigo control in 70–80% of patients after surgery.

Risks and Possible Complications

Although generally safe, potential risks include

1. Temporary dizziness or imbalance
2. Infection or bleeding
3. Hearing changes (rare)
4. Facial nerve injury (very rare)
5. CSF leak (extremely uncommon)

Choosing an experienced ENT surgeon significantly minimizes these risks.

Recovery After Endolymphatic Sac Surgery

Most patients are discharged within 1–2 days after surgery.

Recovery Timeline

1. Mild dizziness for a few days
2. Stitches removed after 7–10 days
3. Return to light activities within 1–2 weeks
4. Complete recovery in 4–6 weeks

Patients are advised to avoid heavy lifting, sudden head movements, and air travel during early recovery.

Post-Surgery Care and Follow-Up

Postoperative care includes

1. Prescribed antibiotics and pain medication
2. Vestibular rehabilitation if needed
3. Regular follow-up visits
4. Hearing tests to monitor improvement

Lifestyle modifications such as low-salt diet and stress management continue to support long-term results.

Success Rate and Long-Term Outcomes

Endolymphatic Sac Surgery has shown favorable long-term outcomes

1. Long-term vertigo control in majority of patients
2. Hearing preservation in over 80% of cases
3. Improved daily functioning and reduced anxiety

Some patients may still experience mild symptoms, but their frequency and severity are significantly reduced.

Alternatives to Endolymphatic Sac Surgery

If surgery is not suitable, alternatives include

1. Intratympanic steroid injections
2. Gentamicin injections
3. Vestibular nerve section
4. Labyrinthectomy (for severe, hearing-loss cases)

Your doctor discusses all options before finalizing treatment.

Conclusion

Endolymphatic Sac Surgery is a proven and effective treatment for patients with disabling Ménière’s disease who do not respond to conservative management. By reducing inner ear pressure while preserving hearing, this surgery offers lasting relief from vertigo and improves quality of life. Early diagnosis, expert surgical care, and proper follow-up play a crucial role in achieving successful outcomes.