Endolymphatic sac occlusion for the enlarged vestibular aqueduct syndrome

Objective: To test the efficacy of occlusion of the enlarged vestibular aqu educt to treat the progressive sensorineural hearing loss associated with t he enlarged vestibular aqueduct (EVA) syndrome. Study Design: Prospective controlled study. Setting: Tertiary care referral center. Patients: Sixteen consecutive patients (29 affected ears) with progressive sensorineural hearing loss and vestibular aqueducts >1.5 mm in diameter wit hout other inner ear anomalies participated in this study. Intervention: In 10 patients with progressive hearing loss, the EVA was occ luded in the ear with worse hearing by placing a fascia graft between the p osterior fossa dura overlying the endolymphatic sac and intraosseous duct a nd the posterior semicircular canal without opening the endolymphatic sac. In the operative ears, serial postoperative audiograms were compared with t he contralateral ear in patients with bilateral EVA and with the other nono perated control ears. Main Outcome Measures: The rate of decline of pure-tone average and speech discrimination before surgery in the operated ear was compared with the rat e of decline postoperatively in the same ear. The rates of decline in the n onoperated contralateral ear from the same patient and the nonoperated cont rol ears from other patients were also used for comparison with the postope rative rate of decline in the operated ears. Results: There was no statistically significant change in the rate of heari ng loss in patients undergoing occlusion of the EVA. Conclusions: Extraluminal soft-tissue occlusion of the EVA appears to be a safe procedure but has not yet been shown to be significantly effective in altering the sensorineural hearing loss accompanying the EVA syndrome. Furt her surgical intervention does not appear warranted until such time that lo ngitudinal follow-up shows sufficient evidence of efficacy of the procedure .