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The role of endolymphatic mastoid shunt surgery in the managed care era.

OBJECTIVE
Ongoing controversy regarding the surgical management of Meniere's disease has prompted us to review the effectiveness of the endolymphatic mastoid shunt procedure in the control of vertigo. In the current managed care environment in which outcome measures, cost effectiveness, and procedural efficacy must be demonstrated, the surgeon can no longer rely on anecdotal or empirical observations regarding the effectiveness of a treatment paradigm.


STUDY DESIGN
Retrooperative case review.


SETTING
A tertiary care center.


PATIENTS
The records of 327 patients with presumed Meniere's-related vertigo referred to the University of Cincinnati Medical Center were reviewed. One hundred nine patients underwent endolymphatic mastoid shunt. Our study population consists of 96 of these patients that were available for 5 years follow-up.


INTERVENTIONS
Endolymphatic mastoid shunt for the control of medically refractory vertigo.


MAIN OUTCOME MEASURE
Control of vertigo.


RESULTS
Using the Arenberg anatomic classification system, patients with a type I endolymphatic sac achieved 68% control of vertigo, those with a type II endolymphatic sac had a 92% control rate, and patients with a type III endolymphatic sac achieved 78% relief.


CONCLUSIONS
Based on an assessment of outcome variables, we conclude that there remains a definite role for endolymphatic shunt surgery in the contemporary approach to patients with Meniere's disease.