Transcript of video:
When the inner ear retains too much fluid around the nerve endings of hearing themselves, a condition called Endolymphatic Hydrops can develop. Sometimes this develops on its own. Sometimes it develops after injury or trauma. Sometimes it develops as a result of allergies, but the end result is that people will often notice fullness in the ear, some fluctuation in the hearing, and sometimes dizziness that can come as spells of imbalance. It can come as spells of spinning vertigo. Sometimes the ear can develop this extra fluid as a result of the migraine process. Because of the circulation changes related to migraine, the fluid can back up. Our first treatment for this buildup of inner ear fluid when you Endolymphatic Hydrops is to use special diet changes – watch the salt and watch the caffeine in your diet. We will often use a diuretic or a water pill to try to dry the ear.
Sometimes we will use a medication called histamine or betahistine to improve the circulation to the inner ear. This medicine is a natural compound that your body makes all the time. Some patients are confused because it sounds like a common medicine called an antihistamine. But the fact is you can use histamine even if you’re taking antihistamines because we’re working on the receptors in the brain when we use that medication.
When medical management isn’t enough, there is a procedure where we can help the ear drain that excess fluid. That procedure is called an endolymphatic sac decompression. So we know that the inner ear contains this fluid. We call that endolymph, and that fluid drains through a path into the back of the ear called the mastoid. The place where that fluid drains is called the endolymphatic sac. This is a thickening of the lining around the brain which is actually encased in bone.
In the mastoid itself: we’re all born with a little tiny space where that sack sits. For the normal amount of fluid, that works out just fine, but if you have extra fluid, then that tiny space constricts the sac. This surgery goes from behind the ear. We remove some of the honeycomb of the bone in the mastoid and then take the bone off of that sac so it can expand and drain the extra fluid better. In our studies, we have found that 80% of patients who have this procedure have an improvement in their symptoms. For people who have spinning vertigo, for 60% of patients, it stops the spinning vertigo altogether.
It’s important to know that the endolymphatic sac decompression is a help. It’s not a cure when you have endolymphatic hydrodrops, but as part of an overall treatment, it’s a nice way to avoid some of the more destructive treatments to the inner ear, and the patients have noticed a significant improvement.
The risk of problems with this operation is low, but like any surgery, we mention risks of anesthesia problems, bleeding issues, or even infection issues. These are very uncommon and any time we touch the ear with a surgery, we always mention risks to the ear. They are rare, but we need to mention that there is always a risk of further hearing loss or worsening of dizziness, or even weakness of the face, or even leakage of fluids. It is incredibly unlikely to develop those things, but anytime you have a surgical procedure, you need to be aware that there are risks, and that’s why we start with medical management first.
The whole operation lasts about 40 minutes, but after surgery, we tell adults the same thing we tell little kids – one week off school, two weeks, no gym, basically, no heavy lifting for a couple of weeks.
Articles by Dr. Arriaga on Endolymphatic Hydrops
