Impact of endolymphatic mastoid shunt surgery on saccule and lateral semicircular canal function

  • Jonas Jae-Hyun Park
  • Yue-Shih Chen
  • Martin Westhofen


Endolymphatic mastoid shunt surgery (EMSS) is widely performed in patients with medically intractable Meniere’s disease. Although many patients report an improvement of symptoms after surgery, the mechanisms which are responsible for the relief of complaints are not known. To date, only few studies exist which studied the influence of EMSS on vestibular function. The present study examines the effect of EMSS on saccule function by measuring vestibular evoked myogenic potentials and the effect on lateral semicircular canal function by sinusoidal harmonic acceleration (SHA) testing. No changes in vestibulo-collic reflexes were found after surgery compared to before surgery. SHA testing resulted in comparable phase lag and gain pre- and postoperatively. Although central compensation is clinically evident no effect in specific vestibular diagnostic testing is seen. Modulations of canal–otolith interaction might suggest a change of symptoms. The only method so far to evaluate the success of EMSS is the patient’s subjective assessment.


Endolymphatic shunt surgery Meniere’s disease VEMP Sinusoidal harmonic acceleration Canal–otolith interaction 


  1. 1.
    Portmann G (1991) The saccus endolymphaticus, an operation for draining the same for the relief of vertigo 1927. J Laryngol Otol 105(12):1109–1112CrossRefPubMedGoogle Scholar
  2. 2.
    Portmann G (1965) Symposium: management of Meniere’s disease. IV. Surgical treatment of vertigo by the opening of the endolymphatic sac. Laryngoscope 75(10):1522–1532PubMedGoogle Scholar
  3. 3.
    House WF (1962) Subarachnoid shunt for drainage of endolymphatic hydrops. A preliminary report. Laryngoscope 72:713–729PubMedGoogle Scholar
  4. 4.
    Shea JJ (1966) Teflon film drainage of the endolymphatic sac. Arch Otolaryngol 83(4):316–319PubMedGoogle Scholar
  5. 5.
    Paparella MM, Hanson DG (1976) Endolymphatic sac drainage for intractable vertigo (method and experiences). Laryngoscope 86(5):697–703CrossRefPubMedGoogle Scholar
  6. 6.
    Arenberg IK, Spector GJ (1977) Endolymphatic sac surgery for hearing conservation in Meniere disease. Arch Otolaryngol 103(5):268–270PubMedGoogle Scholar
  7. 7.
    Goldenberg RA, Justus MA (1983) Endolymphatic mastoid shunt for treatment of Meniere’s disease: a five year study. Laryngoscope 93(11 Pt 1):1425–1429PubMedGoogle Scholar
  8. 8.
    Brackmann DE, Nissen RL (1987) Meniere’s disease: results of treatment with the endolymphatic subarachnoid shunt compared with the endolymphatic mastoid shunt. Am J Otol 8(4):275–282PubMedGoogle Scholar
  9. 9.
    Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 113:181–185Google Scholar
  10. 10.
    Matsuoka I, Kurata K, Nishida Y, Ogata T, Iwasaki S, Ishizaki H (1989) Effects of endolymphatic mastoid shunt operation for patients with Meniere’s disease. Acta Otolaryngol Suppl 468:105–116CrossRefPubMedGoogle Scholar
  11. 11.
    Huang TS, Lin CC, Chang YL (1991) Endolymphatic sac surgery for Meniere’s disease. A cumulative study of twelve years’ experience. Acta Otolaryngol Suppl 485:145–154CrossRefPubMedGoogle Scholar
  12. 12.
    Pensak ML, Friedman RA (1998) The role of endolymphatic mastoid shunt surgery in the managed care era. Am J Otol 19(3):337–340PubMedGoogle Scholar
  13. 13.
    Moffat DA (1997) Endolymphatic mastoid shunt surgery in unilateral Meniere’s disease. Ear Nose Throat J 76(9):642–648, 650PubMedGoogle Scholar
  14. 14.
    Spector GJ, Smith PG (1983) Endolymphatic sac surgery for Meniere’s disease. Ann Otol Rhinol Laryngol 92(2 Pt 1):113–118PubMedGoogle Scholar
  15. 15.
    Arenberg IK (1987) Results of endolymphatic sac to mastoid shunt surgery for Meniere’s disease refractory to medical therapy. Am J Otol 8(4):335–344PubMedGoogle Scholar
  16. 16.
    Thomsen J, Bretlau P, Tos M, Johnsen NJ (1981) Placebo effect in surgery for Meniere’s disease. A double-blind, placebo-controlled study on endolymphatic sac shunt surgery. Arch Otolaryngol 107(5):271–277PubMedGoogle Scholar
  17. 17.
    Bretlau P, Thomsen J, Tos M, Johnsen NJ (1984) Placebo effect in surgery for Meniere’s disease: a three-year follow-up study of patients in a double blind placebo controlled study on endolymphatic sac shunt surgery. Am J Otol 5(6):558–561PubMedGoogle Scholar
  18. 18.
    Thomsen J, Bretlau P, Tos M, Johnsen NJ (1986) Endolymphatic sac-mastoid shunt surgery. A nonspecific treatment modality? Ann Otol Rhinol Laryngol 95(1 Pt 1):32–35PubMedGoogle Scholar
  19. 19.
    Silverstein H (1978) The effect of the endolymphatic subarachnoid shunt operation on vestibular function. Laryngoscope 88(10):1603–1611CrossRefPubMedGoogle Scholar
  20. 20.
    Pappas DG (1983) Endolymphatic shunt: an evaluation by test results. Laryngoscope 93(8):1013–1017CrossRefPubMedGoogle Scholar
  21. 21.
    Futaki T, Ikeda T (1989) The Auto-Tilt test in patients with positional vertigo and Meniere’s disease. Am J Otol 10(4):289–292PubMedGoogle Scholar
  22. 22.
    Ulubil SA, Eshraghi AA, Telischi FF, Angeli SI, Balkany TJ, Joy JJ (2008) Caloric function after endolymphatic sac surgery. Laryngoscope 118(2):295–299CrossRefPubMedGoogle Scholar
  23. 23.
    Palomar-Asenjo V, Boleas-Aguirre MS, Sanchez-Ferrandiz N, Fernandez NP (2006) Caloric and rotatory chair test results in patients with Meniere’s disease. Otol Neurotol 27:945–950CrossRefPubMedGoogle Scholar
  24. 24.
    Brinson GM, Chen DA, Arriaga MA (2007) Endolymphatic mastoid shunt versus endolymphatic sac decompression for Menière’s disease. Otolaryngol Head Neck Surg 136(3):415–421CrossRefPubMedGoogle Scholar
  25. 25.
    Dunnebier EA, Segenhout JM, Dijk F, Albers FW (2001) Sensory cell damage in two-phase endolymphatic hydrops: a morphologic evaluation of a new experimental model by low-voltage scanning techniques. Otol Neurotol 22(5):655–661CrossRefPubMedGoogle Scholar
  26. 26.
    Manni JJ, Kuijpers W, Huygen PL, Eggermont JJ (1998) Cochlear and vestibular functions of the rat after obliteration of the endolymphatic sac. Hear Res 36(2–3):139–151Google Scholar
  27. 27.
    Olson JE, Wolfe JW (1996) Practical management of the balance disorder patient. Singular Publishing Group, Inc., San DiegoGoogle Scholar
  28. 28.
    Angelaki DE, McHenry MQ, Dickman JD, Newlands SD, Hess BJ (1999) Computation of inertial motion: neural strategies to resolve ambiguous otolith information. J Neurosci 19(1):316–327PubMedGoogle Scholar
  29. 29.
    Merfeld DM, Young LR (1995) Modeling the vestibulo-ocular reflex of the squirrel monkey during eccentric rotation and roll tilt. Exp Brain Res 106(1):111–122PubMedGoogle Scholar
  30. 30.
    Merfeld DM, Zupan L, Peterka RJ (1999) Humans use internal models to estimate gravity and linear acceleration. Nature 398(6728):615–618CrossRefPubMedGoogle Scholar
  31. 31.
    Crane BT, Viirre ES, Demer JL (1997) The human horizontal vestibulo-ocular reflex during combined linear and angular acceleration. Exp Brain Res 114(2):304–320CrossRefPubMedGoogle Scholar
  32. 32.
    Anastasopoulos D, Gianna CC, Bronstein AM, Gresty MA (1996) Interaction of linear and angular vestibulo-ocular reflexes of human subjects in response to transient motion. Exp Brain Res 110(3):465–472CrossRefPubMedGoogle Scholar
  33. 33.
    Angelaki DE, Newlands SD, Dickman JD (2002) Inactivation of semicircular canals causes adaptive increases in otolith-driven tilt responses. J Neurophysiol 87(3):1635–1640PubMedGoogle Scholar
  34. 34.
    Peterka RJ, Gianna-Poulin CC, Zupan LH, Merfeld DM (2004) Origin of orientation-dependent asymmetries in vestibulo-ocular reflexes evoked by caloric stimulation. J Neurophysiol 92(4):2333–2345CrossRefPubMedGoogle Scholar
  35. 35.
    Westhofen M (2007) Otolith-ocular responses in Meniere’s patients before and after endolymphatic shunt operation. J Vestib Res 17(2–3):113–118PubMedGoogle Scholar
  36. 36.
    Furman JM, Hsu LC, Whitney SL, Redfern MS (2003) Otolith-ocular responses in patients with surgically confirmed unilateral peripheral vestibular loss. J Vestib Res 13(2–3):143–151PubMedGoogle Scholar
  37. 37.
    Blakley BW, Barber HO, Tomlinson RD, McIlmoyl L (1989) Changes in the time constants of the vestibulo-ocular reflex and optokinetic afternystagmus following unilateral ablative vestibular surgery. J Otolaryngol 18(5):210–217PubMedGoogle Scholar
  38. 38.
    Brantberg K, Fransson PA, Magnusson M, Johansson R, Bergenius J (1995) Short vestibulo-ocular reflex time-constant in complete unilateral vestibular lesions. Am J Otol 16(6):787–792PubMedGoogle Scholar
  39. 39.
    Gresty MA, Hess K, Leech J (1977) Disorders of the vestibulo-ocular reflex producing oscillopsia and mechanisms compensating for loss of labyrinthine function. Brain 100(4):693–716CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jonas Jae-Hyun Park
    • 1
  • Yue-Shih Chen
    • 1
  • Martin Westhofen
    • 1
  1. 1.Department of Otorhinolaryngology and Head and Neck SurgeryRWTH University AachenAachenGermany

Personalised recommendations