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).