RESULTS
In this study, the demographic and symptoms information on the patients
undergoing TSCO combined with ESD are presented in Table 1. In brief, 19
male and 27 female patients (male: female ratio = 0.70: 1) were
included. The mean age of these patients at the time of surgery was 58
years (ranging from 33 to 79 years). The duration of disease was 118.2
months (ranging from 48 to 360 months), and the vertigo episodes during
the last 6 months occurred an average of 6.84 times (ranging from 2 to
42 times). All patients in this study complained of hearing loss, and
most of them suffered from aural fullness and tinnitus, especially
during the vertigo episode.
Post-operatively, all patients suffered from temporary vertigo and
imbalance and presented with spontaneous nystagmus immediately
post-operatively. Vertigo disappeared in all patients within 3 days,
while the imbalance was alleviated in all patients within 4-5 days, and
30 patients totally recovered their balance within 2 months, with an
average recovery time of 12.6 days. However, there were 4 patients who
still felt unstable or like they were floating at the latest follow-up
interview because none of them persisted with vestibular rehabilitation
postoperatively. No patients had facial paralysis, cerebrospinal fluid
leakage, infection, or other complications.
The overall control rate of vertigo post-operatively was 100% in the
whole follow-up, with a complete control rate of 97.8% (45/46) and a
substantial control rate of 2.2% (1/46). The average numbers of vertigo
attacks over the course of 6 months pre- and post-operatively was
6.727±7.807 and 0.0625±0.348 (F = 499.67, p = 0.000 ),
respectively. Only one patient suffered from two vertigo attacks in the
6 months post-operatively (Table 2). However, the vertigo was alleviated
when the patients took diuretics and betahistine, and never reoccurred
over the course of the entire follow-up time. The number of patients
suffering from aural fullness pre- and post-operatively was 44 and 0
(p=0.000 ), respectively (Table 2). Out of the 46 patients
included in this study, 38 patients suffered from persistent or
bothersome tinnitus preoperatively. However, this number was decreased
to 12 (X2=21.959, p= 0.000 ) postoperatively
(Table 2). The tinnitus evaluation was carried out according to theClinical Practice Guideline: Tinnitus (2014) 11.
According to the pre-operative staging of hearing, among these 46
patients, there were 2 in stage I, 11 in stage II, 21 in stage III and
12 in stage IV. Fifteen patients had unserviceable hearing
pre-operatively (PTA more than 60 dB HL). No patients in stage I or II
suffered from hearing deterioration postoperatively. However, 6 patients
(6/21, 28.57%) in stage III presented with hearing deterioration 6
months postoperatively when compared with their preoperative state. That
number increased to 9 (9/21, 42.86%) and 16 (16/21, 76.19%) at 12
months and 18 months postoperatively, respectively. Otherwise, patients
in stage IV presented hearing deterioration were 2 (2/12, 16.67%), 3
(3/12, 25%), and 5 (5/12, 41.67%) at 6, 12, and 18 months
postoperative, respectively. Finally, there was a
total of 21 patients (21/46,
45.65%) suffering from hearing deterioration at 18 months
postoperatively, and all patients suffering from hearing deterioration
were at stage III and IV. The rate of hearing preservation was only
54.35% at 18 months postoperatively (Table 3). The overall PTA was
59.33±17.2 dB HL and 68.28±24.0 dB HL pre-operatively and
post-operatively, respectively, which reflected a significant difference
compared between pre- and postoperatively (Table 2).