Department of Otolaryngology Head and Neck Surgery, West Virginia University, Morgantown, WV, USA

■ OBJECTIVES: The goal is to evaluate the results of treating patients with intractable Meniere’s disease with the endolymphatic sac procedure.

■ METHODS: A retrospective chart review was performed to find 83 sac procedures performed by a single surgeon between August 1988 and March 2004. The minimum follow-up period for inclusion in the study was 2 years or failure of the procedure. This report includes 51 primary cases and 16 revision cases. Excluded were four cases that, in retrospect, did not have Meniere’s disease, and 12 cases lost to follow-up prior to two years.

■ RESULTS: Complete control of vertigo (Class A) at 2 years follow-up was achieved in 57% of cases, and partial control (Class B) was achieved in an additional 20% resulting in a complete or partial control of vertigo in 77%. Nine of the cases that failed within the first two years after the original procedure underwent revision sac surgery. One-third of those cases achieved Class A results but onethird underwent further surgical treatment consisting of vestibular nerve section or labyrinthectomy. Additionally, 7of the patients who were considered successes after 2 years of follow-up failed later and underwent revision sac surgery an average of 50 months (range 28- 94 months) after their original procedure. All of these patients achieved Class A or B results at 24 months following revision surgery. In the 33 cases with long-term follow-up averaging 7 years, complete or partial control of vertigo occurred in 94% of cases.

■ CONCLUSIONS: Partial or complete control of vertigo occurred in 77% of patients at 2 years after endolymphatic sac surgery for Meniere’s disease. The 14% of patients (7 of 51) who failed after two years follow-up underwent revision sac procedures and all achieved Class A or B results over the subsequent two or more years of followup. Revision sac surgery is more successful in those individuals who achieved a good result within the first two years after their original surgery than in those who fail within the first two years.