| Objective:The study aimed to make a comprehensive evaluation of the postoperative quality of life and long-term clinical efficacy of triple semicircular canal plugging(TSCP)for intractable Meniere’s disease(MD),and to compare it with conventional labyrinthectomy in order to provide a reference for the management strategy of MD.Methods:From September 2015 to September 2020,the study retrospectively analyzed the case data of patients with unilateral definite Meniere’s disease,being admitted to Vertigo Disease Department,Shandong Provincial ENT Hospital and treated with TSCP or labyrinthectomy.The inclusion criteria were that patients diagnosed with intractable Meniere’s disease which met the 2015 Barany Society Meniere’s disease diagnostic criteria.Exclusion criteria were that patients with bilateral Ménière’s disease,cerebellopontine horn tumors and/or other intracranial occupying lesions,other diseases causing vertigo such as vestibular migraine,sudden deafness,benign paroxysmal positional vertigo,vaginitis,vestibular neuritis,vestibular paroxysmal drug-induced vertigo,and posterior circulation ischemia.We conducted postoperative follow-up for all patients,including balance recovery time,vertigo control,auditory function,Ménière’s disease outcomes questionnaire(MDOQ),Functional Level Scale(FLS),Dizziness Handicap Inventory(DHI)and Vertigo Symptom Scale short form(VSS-sf),which were recorded in one by one and evaluated comprehensively.Changes in quality of life(QOL)after TSCP and labyrinthectomy for MD were investigated,as well as factors that may be associated with changes in postoperative quality of life.Results:A total of 195 patients with advanced MD were included,97 males and 98 females,including 142 in the TSCP group and 53 in the labyrinthectomy group.The overall control rate of vertigo was 97.18%in the TSCP group and 100.00%in the labyrinthectomy group.The difference of vertigo control efficiency between the two groups was not statistically significant(P>0.05).The postoperative hearing loss rate in the TSCP group was 20.74%and 100.00%in the labyrinthectomy group.The postoperative hearing loss rate in the TSCP group was much lower than that in the labyrinthectomy group(P<0.01).In the intra-group comparison,it was found that there was no statistically significant difference between the cVEMP or oVEMP abnormality rates before and after surgery in the TSCP group(P>0.05),but the cVEMP and oVEMP abnormality rates before and after surgery in the labyrinthectomy group were statistically significant(P<0.05).When comparing between groups,the differences in postoperative VEMP abnormality rates were not statistically significant(P>0.05),but there was a statistically significant difference between TSCP and labyrinthectomy groups in postoperative VEMP(P<0.01).The equilibrium recovery time in the TSCP group was 15.13±2.86 days and 23.85±4.76 days in the labyrinthectomy group,with a statistically significant difference(P<0.05).The postoperative MDOQ total score and its three subscales(S,P,M)scores were significantly higher than preoperative scores in the TSCP group,and the differences in scores before and after surgery were statistically significant(P<0.05).The scores of FLS,VSS-sf,DHI and subscales were higher than that before surgery,with differences in scores statistically significant(P<0.05).There were differences in the total scores of MDOQ and its three subscales before and after surgery in the labyrinthotomy group,which were statistically significant(P<0.05).The differences were statistically significant in the pre-and post-surgery total scores of FLS,VSS-sf,DHI scales and there subscales(P<0.05).The change in the total score of MDOQ and its subscale mental(M)was more significant in the TSCP group than in the labyrinthectomy group before and after surgery,with a statistically significant difference(P<0.05).The changes of the DHI total score with its subscales physical(P)and functional(F)items were more significant in the TSCP group than in the labyrinthectomy group,and the differences were statistically significant(P<0.05).In the TSCP group,correlation analysis revealed a statistically significant correlation(P<0.05)between the score changes of MDOQ and VSS-sf,MDOQ and VSS-sf subscale vertigo(V),with r values of 0.391 and 0.559,respectively.There were statistically significant correlations between the score changes of MDOQ subscale living status(S)and VSS-sf subscale vertigo(V),MDOQ subscale living status(S)and physical(P)of the DHI subscale(P<0.05).None of the remaining functional indicators had significant correlations with the pre-and post-surgery score differences of quality of life(P>0.05).In the labyrinthectomy group,there were statistically significant in the correlation between the score changes of MDOQ with all of its subscales and VSS-sf,MDOQ with all of its subscales and VSS-sf subscale vertigo(V)items(P<0.05).The correlation between the score improvement of DHI with its subscale function(F)items and MDOQ’s mental(M)was statistically significant(P<0.05),with r values of 0.371 and 0.318,respectively.There was no significant correlation between the remaining indicators and improved quality of life after surgery(P value>0.05).Conclusion:The control rate of vertigo in TSCP group is comparable to that of labyrinthectomy.Compared with labyrinthectomy,TSCP can partially preserve hearing and otolithic function,and balance recovery is more quickly.The postoperative quality of life is significantly improved in both TSCP and labyrinthectomy groups.The improvement of quality of life in TSCP group is more obvious.Besides,the improvement in quality of life was positively correlated with the control of vertigo symptoms in both two groups. |
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