Topical mitomycin C and cephalosporin in endolymphatic sac surgery

Objective. To determine whether intraoperative topical application of the drug mitomycin C to the endolymphatic sac area in conjunction with endolymphatic sac ballooning surgery (ESBS) can safely achieve longer-lasting relief from incapacitating, medically intractable Meniere symptom-complex than ESBS alone. Study Design/Method: A retrospective study is presented of 142 cases of ESBS performed by the author between May 1998 and November 1999, in which a solution of mitomycin C diluted to 1 mg/mL of physiological saline was applied to the sac area for 5 minutes followed by irrigation with a cephalosporin antibiotic solution. The results of the 103 of 142 cases diagnosed as classic Meniere's disease or endolymphatic hydrops are given special attention, comparing them with the results of an earlier-reported series of 109 cases of ESBS sharing the same diagnostic and result evaluation criteria but not using mitomycin C. Results: In terms of vertigo control, the comparative short-term rates (<3 y) of complete/substantial control for the aforementioned 103-case series and earlier 109-case series are similar: respectively, 90.3% (after 1.5-3 years' follow-up) versus 91.7% (after 2.5-3 years' follow-up). In the 103-case series, to date, there has been no recurrence of incapacitating vertiginous symptoms necessitating revision surgery, whereas in the 109-case series, although there were likewise no cases necessitating revision surgery during the reported 2.5-to 3-year follow-up period, at least 8 patients in that series are known to have undergone revision surgery at later dates. Hearing results were significantly better (P = .004) in the 103-case series than the 109-case series: respectively, 30.0% versus 12.8% hearing improvement. Conclusions: Preliminarily, the superior hearing results in the present series indicate that possible adverse effects of mitomycin C on the inner ear and endolymphatic system have been averted; and no recurrence of incapacitating symptoms to date offers hope that longer-term efficacy of endolymphatic sac surgery using mitomycin C can be maintained.