Endolymphatic sac operation; with shunt
CPT4 code
Name of the Procedure:
Endolymphatic Sac Operation with Shunt
Common name(s): Endolymphatic sac decompression, Endolymphatic shunt surgery
Summary
An endolymphatic sac operation with a shunt is a surgical procedure aimed at relieving fluid pressure in the inner ear. This helps to alleviate symptoms related to Meniere's disease, such as vertigo, hearing loss, and tinnitus.
Purpose
This procedure addresses issues caused by excess fluid buildup in the inner ear, specifically targeting Meniere's disease. The primary goal is to reduce vertigo attacks, improve hearing, and relieve tinnitus by draining excess endolymphatic fluid.
Indications
- Persistent, severe vertigo spells that impact daily life
- Fluctuating hearing loss
- Chronic tinnitus
- Patients with Meniere's disease who have not responded adequately to other treatments like medication or lifestyle changes
Preparation
- Patients may be advised to fast for a specified period before surgery.
- Medications, particularly blood thinners, may need to be adjusted.
- Preoperative tests like hearing tests (audiometry) and balance tests might be required.
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: A small incision is made behind the ear.
- Accessing the Sac: The endolymphatic sac is identified and accessed.
- Shunt Placement: A small tube (shunt) is inserted into the sac to facilitate fluid drainage.
- Closure: The incision is closed using stitches or surgical staples.
Specialized surgical tools and possibly an operating microscope are used to enhance precision.
Duration
The procedure typically takes around 1 to 2 hours.
Setting
The surgery is usually performed in a hospital or surgical center.
Personnel
- ENT surgeon (otolaryngologist)
- Anesthesiologist
- Surgical nursing staff
Risks and Complications
- Infection at the surgical site
- Dizziness or imbalance post-surgery
- Hearing loss or changes in hearing
- Cerebrospinal fluid leakage
- Rare risk of facial nerve injury
Benefits
Many patients experience a significant reduction in vertigo episodes and may notice improvements in hearing and tinnitus. Benefits are often realized within weeks to months after surgery.
Recovery
- Patients might go home the same day or stay overnight for observation.
- Post-operative instructions include keeping the surgical site clean and dry, avoiding heavy lifting, and adhering to follow-up appointments.
- Recovery time varies but typically ranges from a few weeks to several months with progressive improvements.
Alternatives
- Medical management with diuretics and lifestyle modifications
- Intratympanic steroid injections
- Vestibular rehabilitation therapy
- Labyrinthectomy or vestibular nerve section (in more severe, unilateral cases)
Each alternative comes with its own set of benefits and risks, often considered based on individual patient needs and severity of symptoms.
Patient Experience
During the procedure, patients are under anesthesia and will not feel any pain. Post-operatively, they might experience some discomfort, dizziness, and ear pressure. Pain management includes prescribed analgesics, and most discomfort should subside within a few days.
Patients are encouraged to follow all post-operative care instructions closely to ensure optimal recovery and minimize potential complications. Regular follow-up visits will help monitor progress and address any concerns promptly.